Provider Demographics
NPI:1447571518
Name:YOO, JANE YOUNG (MD, MPP)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:YOUNG
Last Name:YOO
Suffix:
Gender:F
Credentials:MD, MPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 W 56TH ST STE 304-305
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3831
Mailing Address - Country:US
Mailing Address - Phone:646-844-0424
Mailing Address - Fax:646-344-1053
Practice Address - Street 1:162 W 56TH ST STE 304-305
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3831
Practice Address - Country:US
Practice Address - Phone:646-844-0424
Practice Address - Fax:646-344-1053
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52761207N00000X
NY262903207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA09738000OtherNJ STATE LICENSE
MA261951OtherMA STATE LICENSE
NY1225486624OtherPRACTICE NPI
1447571518OtherNPI
CT52761OtherCT STATE LICENSE
NY262903OtherNY STATE LICENSE
RIMD15086OtherRI STATE LICENSE
NY1225486624OtherPRACTICE NPI
NY262903OtherNY STATE LICENSE