Provider Demographics
NPI:1932111614
Name:YOO, JONG HYEON (MD)
Entity Type:Individual
Prefix:DR
First Name:JONG
Middle Name:HYEON
Last Name:YOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 OLD DENTON RD STE 415
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5112
Mailing Address - Country:US
Mailing Address - Phone:972-242-3361
Mailing Address - Fax:972-242-5678
Practice Address - Street 1:2625 OLD DENTON RD STE 415
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5112
Practice Address - Country:US
Practice Address - Phone:972-242-3361
Practice Address - Fax:972-242-5678
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081721207R00000X
TXS1021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR858464043OtherBCBS-SPRINGFIELD
OR028545Medicaid
OR838334042OtherBCBS-ROSEBURG
OR838366041OtherBCBS-MCMINNVILLE
OR844477038OtherBCBS-GRANTS PASS
OR858463043OtherBCBS-MEDFORD
ORP00424198OtherRAIL ROAD MEDICARE
OR858464043OtherBCBS-SPRINGFIELD
OR858463043OtherBCBS-MEDFORD
OR136163Medicare PIN