Provider Demographics
NPI:1720083652
Name:JOO, JOHN YOHAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:YOHAN
Last Name:JOO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N 185TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4011
Mailing Address - Country:US
Mailing Address - Phone:206-542-5323
Mailing Address - Fax:206-542-5353
Practice Address - Street 1:1130 N 185TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4011
Practice Address - Country:US
Practice Address - Phone:206-542-5323
Practice Address - Fax:206-542-5353
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO 00000700213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1295934438OtherGROUP NPI #
WA5311450001OtherDMEPOS
WA1115773Medicaid
WA1121144OtherDSHS
WAU84791Medicare UPIN
GAB36984Medicare PIN
WA1115773Medicaid
WAG8851708Medicare PIN
WA5311450001Medicare NSC