Provider Demographics
NPI:1235110552
Name:YOO, DON CHAN (MD)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:CHAN
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 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-453-8220
Practice Address - Street 1:125 METRO CENTER BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1785
Practice Address - Country:US
Practice Address - Phone:401-432-2520
Practice Address - Fax:401-453-8220
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2174222085R0202X
RIMD113672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
003123859OtherCT MED ASSISTANCE
411591OtherBLUE CHIP
AA21773OtherRIHPILGRIM
9281684OtherPHHCS
9208788OtherCIGNA
2008751OtherMASS MEDICAID
1988OtherNHPRI
9003453OtherRI MEDICAL ASSISTANCE
P00137143OtherRAILROAD MEDICARE
AA21773OtherRIHPILGRIM
9208788OtherCIGNA