Provider Demographics
NPI:1568626042
Name:YI, JUNG SOO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUNG
Middle Name:SOO
Last Name:YI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:YI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9500 GILMAN DRIVE 0801
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY UCSD
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0801
Mailing Address - Country:US
Mailing Address - Phone:619-543-3162
Mailing Address - Fax:
Practice Address - Street 1:9500 GILMAN DRIVE 0801
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0801
Practice Address - Country:US
Practice Address - Phone:619-543-3162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104441207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology