Provider Demographics
NPI:1790106912
Name:JACOBSON, EMILY YOUNG CHOO (RDH)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:YOUNG CHOO
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8357 SW 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3903
Mailing Address - Country:US
Mailing Address - Phone:503-753-9165
Mailing Address - Fax:
Practice Address - Street 1:12000 SE 82ND AVE
Practice Address - Street 2:SUITE 1145
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97086-7721
Practice Address - Country:US
Practice Address - Phone:503-653-9870
Practice Address - Fax:503-653-0180
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6252124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist