Basic Information
| Provider Information | |||||||||
| NPI: | 1942468962 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOO | ||||||||
| FirstName: | JAYNE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 C ST STE 1400 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958163367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167346111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3301 C ST STE 1400 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958163367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167346111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2008 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | A109963 | CA | N | Allopathic & Osteopathic Physicians | Dermatology | 207NS0135X | A109963 | CA | N | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology | 207ND0101X | A109963 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery |
No ID Information.