Provider Demographics
NPI:1417450073
Name:YOO, MINJIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MINJIN
Middle Name:
Last Name:YOO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 KING GEORGE RD APT B-221
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2812
Mailing Address - Country:US
Mailing Address - Phone:202-999-7886
Mailing Address - Fax:
Practice Address - Street 1:7 S MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1578
Practice Address - Country:US
Practice Address - Phone:202-999-7886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12219390200000X
NJ22DI028851001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program