Provider Demographics
NPI:1467066654
Name:YOO, JADEN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JADEN
Middle Name:
Last Name:YOO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 CORTE TORERO
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6531
Mailing Address - Country:US
Mailing Address - Phone:949-812-2662
Mailing Address - Fax:
Practice Address - Street 1:1902 CORTE TORERO
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-6531
Practice Address - Country:US
Practice Address - Phone:949-812-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298170225100000X
GA016008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist