Provider Demographics
NPI:1255405429
Name:YOO, JEUNG CJOO (MD)
Entity type:Individual
Prefix:DR
First Name:JEUNG
Middle Name:CJOO
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 1:26063 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6506
Mailing Address - Country:US
Mailing Address - Phone:909-381-4354
Mailing Address - Fax:951-845-1773
Practice Address - Street 1:264 N HIGHLAND SPRINGS AVE
Practice Address - Street 2:2B
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3082
Practice Address - Country:US
Practice Address - Phone:951-845-1603
Practice Address - Fax:951-845-1773
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA32076OtherMEDICAL LICENSE
CA00A320760Medicaid
CA00A320760Medicaid
CAA26689Medicare UPIN
CAAY 8451584OtherDEA