Provider Demographics
NPI:1124136031
Name:CHAE, YOUNG SOO (MD)
Entity type:Individual
Prefix:MRS
First Name:YOUNG
Middle Name:SOO
Last Name:CHAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2 STATE ROUTE 27
Mailing Address - Street 2:SUITE #111
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3961
Mailing Address - Country:US
Mailing Address - Phone:732-632-8094
Mailing Address - Fax:732-632-8096
Practice Address - Street 1:2 STATE ROUTE 27
Practice Address - Street 2:SUITE 111
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3976
Practice Address - Country:US
Practice Address - Phone:732-632-8094
Practice Address - Fax:732-632-8096
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2012-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06609900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7993609Medicaid
NJ029852Medicare PIN
NJ7993609Medicaid