Provider Demographics
NPI:1891981981
Name:YOO, JI YEOUN (MD)
Entity Type:Individual
Prefix:
First Name:JI YEOUN
Middle Name:
Last Name:YOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE GUSTAVE L. LEVY PLACE
Mailing Address - Street 2:2ND FLOOR / BOS 1052
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-241-2627
Mailing Address - Fax:646-537-9690
Practice Address - Street 1:1468 MADISON AVE,
Practice Address - Street 2:ANNENBERG PAVILLION 2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6574
Practice Address - Country:US
Practice Address - Phone:212-241-2627
Practice Address - Fax:646-537-9690
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070147432084N0400X
NY2731422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400088348Medicare PIN