Individual provider Active NPI

Jenna Yoo, DO

  • Pediatrics Physician
  • Rochester, NY
National Provider Identifier
1386953156
Registry record updated Jun 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
320862 Issued in NY
Practice address
601 Elmwood Ave # 777-R
Rochester, NY 14642-1641
Phone
(585) 275-4174
NPI assigned
Sep 28, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 320862 NY Primary

Addresses

Primary practice location

601 Elmwood Ave # 777-R
Rochester, NY 14642-1641

Mailing address

1305 Prospect Ave
East Meadow, NY 11554-4742

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200923000905 NY Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 2668661786

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
014258NYMDMental Health Counselor
320862NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
PM Pediatrics of Mamaroneck Past Accepting new patients
Zhanna Roit, M.D. P.C Past Accepting new patients
PM Pediatrics PC Pediatrics Past Accepting new patients
D.a.C. Physical Medicine, P.C. PastSince Apr 1, 2004 Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687564800000",
    "number": "1386953156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1305 PROSPECT AVE",
            "city": "EAST MEADOW",
            "state": "NY",
            "postal_code": "115544742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE # 777-R",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146421641",
            "telephone_number": "585-275-4174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOO",
        "first_name": "JENNA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-28",
        "last_updated": "2023-06-24",
        "certification_date": "2023-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "320862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.