Provider Demographics
NPI:1104629195
Name:YOO, YEON JUNG (MD)
Entity type:Individual
Prefix:
First Name:YEON JUNG
Middle Name:
Last Name:YOO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:YOO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:650 S GAINES ST APT 911
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4768
Mailing Address - Country:US
Mailing Address - Phone:503-298-9344
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS RD DEPT OF
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:503-298-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program