Provider Demographics
NPI:1598538118
Name:JO, JACOB YOO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:YOO
Last Name:JO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 WILSHIRE BLVD APT 502
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3555
Mailing Address - Country:US
Mailing Address - Phone:949-402-1323
Mailing Address - Fax:
Practice Address - Street 1:3201 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-5001
Practice Address - Country:US
Practice Address - Phone:213-251-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist