Provider Demographics
NPI:1225348022
Name:YOO, JASON JUNGSUN (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JUNGSUN
Last Name:YOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 GRAND AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1043
Mailing Address - Country:US
Mailing Address - Phone:201-644-1124
Mailing Address - Fax:201-699-0406
Practice Address - Street 1:784 GRAND AVE STE 301
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1043
Practice Address - Country:US
Practice Address - Phone:201-944-1124
Practice Address - Fax:201-699-0406
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA87007500208100000X
PAMD441358208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102577515Medicaid