Provider Demographics
NPI:1952848103
Name:YOO FOOT AND ANKLE PODIATRY, LLC.
Entity Type:Organization
Organization Name:YOO FOOT AND ANKLE PODIATRY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KI-HYUK
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-536-2090
Mailing Address - Street 1:2110 DORCHESTER AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5699
Mailing Address - Country:US
Mailing Address - Phone:617-696-5355
Mailing Address - Fax:617-696-5357
Practice Address - Street 1:2110 DORCHESTER AVE STE 203
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124
Practice Address - Country:US
Practice Address - Phone:617-696-5355
Practice Address - Fax:617-696-5357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110122599AMedicaid