Provider Demographics
NPI:1588735427
Name:YOO, JINWOO (MD)
Entity type:Individual
Prefix:MR
First Name:JINWOO
Middle Name:
Last Name:YOO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12632 DEXTER
Mailing Address - Street 2:
Mailing Address - City:DET
Mailing Address - State:MI
Mailing Address - Zip Code:48238
Mailing Address - Country:US
Mailing Address - Phone:313-868-7700
Mailing Address - Fax:313-868-0303
Practice Address - Street 1:12632 DEXTER
Practice Address - Street 2:
Practice Address - City:DET
Practice Address - State:MI
Practice Address - Zip Code:48238
Practice Address - Country:US
Practice Address - Phone:313-868-7700
Practice Address - Fax:313-868-0303
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031943208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1777671Medicaid
AY5584710OtherDEA
MI1777671Medicaid