Provider Demographics
NPI:1649731043
Name:YOO, CHARLIE JUNG HWAN (DO, MSC)
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:JUNG HWAN
Last Name:YOO
Suffix:
Gender:M
Credentials:DO, MSC
Other - Prefix:
Other - First Name:JUNG
Other - Middle Name:HWAN
Other - Last Name:YOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:11 N 3RD ST APT 10
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-1733
Mailing Address - Country:US
Mailing Address - Phone:215-806-1724
Mailing Address - Fax:
Practice Address - Street 1:1701 N SENATE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5306
Practice Address - Country:US
Practice Address - Phone:317-962-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT019136207X00000X
IN02007863A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery