Active NPI
Sungwon David Yoo, DC, MSAOM, LAC
- Chiropractor
- Fayetteville, NY
National Provider Identifier
1548038557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- X011642-01
- Practice address
- 6868 E Genesee St
Fayetteville, NY 13066-1031 - Phone
- (315) 449-4325
- Fax
- (315) 449-4321
- NPI assigned
- Dec 19, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 003403-01 | NY | |
| Chiropractor | 111N00000X | X011642-01 | NY | Primary |
Addresses
Primary practice location
6868 E Genesee St
Fayetteville, NY 13066-1031
Mailing address
6868 E Genesee St
Fayetteville, NY 13066-1031
Phone (315) 449-4325
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| X011642-01 | NY | MD | Chiropractor |
| 003403-01 | NY | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1702944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702944000000",
"number": "1548038557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6868 E GENESEE ST",
"city": "FAYETTEVILLE",
"state": "NY",
"postal_code": "130661031",
"telephone_number": "315-449-4325",
"fax_number": "315-449-4321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6868 E GENESEE ST",
"city": "FAYETTEVILLE",
"state": "NY",
"postal_code": "130661031",
"telephone_number": "315-449-4325",
"fax_number": "315-449-4321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOO",
"first_name": "SUNGWON",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DC, MSAOM, LAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-12-19",
"last_updated": "2023-12-19",
"certification_date": "2023-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "NY",
"license": "003403-01",
"primary": false
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "NY",
"license": "X011642-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.