Provider Demographics
NPI: | 1932283173 |
---|---|
Name: | YOO, JINIL (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | JINIL |
Middle Name: | |
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: | PO BOX 1239 |
Mailing Address - Street 2: | |
Mailing Address - City: | SCARSDALE |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10583-9239 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 914-636-8591 |
Mailing Address - Fax: | 914-633-5084 |
Practice Address - Street 1: | 4141 CARPENTER AVE |
Practice Address - Street 2: | RENAL UNIT |
Practice Address - City: | BRONX |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10466-2600 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-920-9020 |
Practice Address - Fax: | 718-920-9043 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-24 |
Last Update Date: | 2009-11-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 116868 | 207RN0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
2595083 | Other | GHI | |
3105637 | Other | CIGNA | |
NY | 00216308 | Medicaid | |
NY | 116868 | Other | HIP |
NY | 6X6031 | Other | BLUE CROSS |
4253823 | Other | AETNA | |
GP232 | Other | OXFORD | |
NY | C08224 | Medicare UPIN | |
NY | 00216308 | Medicaid |