1710240114 NPI number — DAL YOO MD LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710240114 NPI number — DAL YOO MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAL YOO MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710240114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNT VALLEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21030-6278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-330-4010
Provider Business Mailing Address Fax Number:
410-771-3820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 VARNUM ST NE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20017-2151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-269-7517
Provider Business Practice Location Address Fax Number:
202-269-7319
Provider Enumeration Date:
06/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
YOO
Authorized Official First Name:
DAL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
202-269-7517

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  MD4360 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: D20782 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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