Provider Demographics
NPI:1639451800
Name:JAE YONG YOO, M.D., INC
Entity Type:Organization
Organization Name:JAE YONG YOO, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUNEE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-590-8370
Mailing Address - Street 1:966 S WESTERN AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1013
Mailing Address - Country:US
Mailing Address - Phone:323-731-2001
Mailing Address - Fax:323-731-1482
Practice Address - Street 1:966 S WESTERN AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1013
Practice Address - Country:US
Practice Address - Phone:323-731-2001
Practice Address - Fax:323-731-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty