Provider Demographics
NPI:1871598367
Name:YOO, HO HYUN (MD)
Entity type:Individual
Prefix:
First Name:HO
Middle Name:HYUN
Last Name:YOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-2016
Mailing Address - Country:US
Mailing Address - Phone:860-224-5675
Mailing Address - Fax:860-224-5774
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5675
Practice Address - Fax:860-224-5774
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY44320207P00000X
OH35084147207P00000X
CT39532207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200477230Medicaid
OH2484379Medicaid
KY64080906Medicaid
H05801Medicare UPIN
KY64080906Medicaid
KYK0010050Medicare PIN
OH4133071Medicare PIN