Basic Information
| Provider Information | |||||||||
| NPI: | 1720083652 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOO | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | YOHAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 N 185TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981334011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065425323 | ||||||||
| FaxNumber: | 2065425353 | ||||||||
| Practice Location | |||||||||
| Address1: | 1130 N 185TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981334011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065425323 | ||||||||
| FaxNumber: | 2065425353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | PO 00000700 | WA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ES0103X | PO 00000700 | WA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1295934438 | 01 | WA | GROUP NPI # | OTHER | 5311450001 | 01 | WA | DMEPOS | OTHER | 1115773 | 05 | WA | MEDICAID | 1121144 | 01 | WA | DSHS | OTHER |