Provider Demographics
NPI:1063564532
Name:YOO, DAL (MD)
Entity type:Individual
Prefix:DR
First Name:DAL
Middle Name:
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 1:63 E MAIN ST
Mailing Address - Street 2:STE 6A
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5036
Mailing Address - Country:US
Mailing Address - Phone:202-636-3811
Mailing Address - Fax:
Practice Address - Street 1:1140 VARNUM ST NE
Practice Address - Street 2:STE 102
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2151
Practice Address - Country:US
Practice Address - Phone:202-636-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD4360207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2674611 00Medicaid
DC43740001OtherBLUE CROSSBLUESHIELD
175794Medicare ID - Type Unspecified