Provider Demographics
NPI:1962606756
Name:YOO, MIN CHONG (MD)
Entity type:Individual
Prefix:
First Name:MIN
Middle Name:CHONG
Last Name:YOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 PARKWAY CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6362
Mailing Address - Country:US
Mailing Address - Phone:479-587-1700
Mailing Address - Fax:479-587-1366
Practice Address - Street 1:3901 PARKWAY CIR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6362
Practice Address - Country:US
Practice Address - Phone:479-587-1700
Practice Address - Fax:479-587-1366
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46777204F00000X
KS0438696204F00000X
CODR.0055751204F00000X
TXN7512204F00000X
MTMED-PHYS-LIC-44826204F00000X
ARE-13943204F00000X
ARE139432086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36604763Medicaid
BP1-0022859OtherINSTITUTIONAL PERMIT
COP01547611OtherMEDICARE RAILROAD
NM72154004Medicaid
COP01547611OtherMEDICARE RAILROAD