Provider Demographics
NPI:1760619316
Name:YOO, YOUNGJA
Entity Type:Individual
Prefix:MRS
First Name:YOUNGJA
Middle Name:
Last Name:YOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YOUNGJA
Other - Middle Name:
Other - Last Name:YOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, LAC
Mailing Address - Street 1:52 WALKER ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3652
Mailing Address - Country:US
Mailing Address - Phone:917-957-0001
Mailing Address - Fax:212-966-8845
Practice Address - Street 1:52 WALKER ST
Practice Address - Street 2:2ND FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3652
Practice Address - Country:US
Practice Address - Phone:917-957-0001
Practice Address - Fax:212-966-8845
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003221171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist