Provider Demographics
NPI:1912420191
Name:YOO, YOUNG C
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:C
Last Name:YOO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3448 ELLICOTT CENTER DR STE 103
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4668
Mailing Address - Country:US
Mailing Address - Phone:301-661-4932
Mailing Address - Fax:
Practice Address - Street 1:3448 ELLICOTT CENTER DR STE 103
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4668
Practice Address - Country:US
Practice Address - Phone:301-661-4932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02404171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU02404OtherACUPUNCTURE