Provider Demographics
NPI:1023071529
Name:YOO, BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
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 1:2007 PALM BEACH LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6501
Mailing Address - Country:US
Mailing Address - Phone:561-688-5808
Mailing Address - Fax:561-420-8560
Practice Address - Street 1:2007 PALM BEACH LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-688-5808
Practice Address - Fax:561-420-8560
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29743207Q00000X
FLME134397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1023071529Medicaid
GA0005915551Medicaid
H80566Medicare UPIN