Provider Demographics
NPI:1780110338
Name:JOO, WOOJIN (MD)
Entity type:Individual
Prefix:
First Name:WOOJIN
Middle Name:
Last Name:JOO
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 1:903 CRENSHAW BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1965
Mailing Address - Country:US
Mailing Address - Phone:310-294-8090
Mailing Address - Fax:310-294-5343
Practice Address - Street 1:903 CRENSHAW BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1965
Practice Address - Country:US
Practice Address - Phone:310-294-8090
Practice Address - Fax:310-294-5343
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA160312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine