Provider Demographics
NPI:1467843128
Name:YU, JEONG MIN
Entity Type:Individual
Prefix:
First Name:JEONG MIN
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:APRIL
Other - Middle Name:
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:375 N LA CIENEGA BLVD UNIT 320
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1956
Mailing Address - Country:US
Mailing Address - Phone:224-388-2526
Mailing Address - Fax:
Practice Address - Street 1:535 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4898
Practice Address - Country:US
Practice Address - Phone:212-774-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY308758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program