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TONY TAEUN JOO D.O.
NPI 1053168716
Student in an Organized Health Care Education/Training Program in Wyoming, MI

Active since May 01, 2024PECOS Enrolled
5900 BYRON CENTER AVE SW, WYOMING, MI 49519(616) 252-7200(616) 252-4953 Get Directions Write a Review

NPPES record last updated: May 1, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Tony Taeun Joo D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TONY TAEUN JOO D.O. (NPI 1053168716) is an individual student in an organized health care education/training program in Wyoming, Michigan and active in the NPI registry since May 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053168716
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameTONY TAEUN JOOCredential: D.O.
Location Address5900 BYRON CENTER AVE SWWyoming, MI 49519-9606
Mailing Address5900 Byron Center Ave SwWyoming, MI 49519-9606 · (616) 252-7200 · Fax (616) 252-4953
Phone(616) 252-7200
Fax(616) 252-4953
Sole ProprietorNo
Enumeration DateMay 1, 2024
NPPES CertifiedMay 1, 2024
✔ NPI 1053168716 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
5900 BYRON CENTER AVE SW, Wyoming, MI 49519
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tony Taeun Joo D.o. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MATTHEW AARON ERCK DO
Internal Medicine
5900 BYRON CENTER AVE SW
WYOMING, MI 49519
Kent County (616) 252-7200
AMANDA BRONSON DO
Student in an Organized Health Care Education/Training Program
5900 BYRON CENTER AVE SW
WYOMING, MI 49519
Kent County (616) 252-7078
GANESH KUMAR DO
Student in an Organized Health Care Education/Training Program
5900 BYRON CENTER AVE SW
WYOMING, MI 49519
Kent County (616) 252-7200
DR. SARAH PRATT DO
Student in an Organized Health Care Education/Training Program
5900 BYRON CENTER AVE SW
WYOMING, MI 49519
Kent County (616) 252-7200
SAMANTHA BLAIR PA-C
Physician Assistant
5900 BYRON CENTER AVE SW
WYOMING, MI 49519
Kent County (812) 909-7200
CASSANDRA PAIGE FRITCH NP
Nurse Practitioner (Family)
5900 BYRON CENTER AVE SW
WYOMING, MI 49519
Kent County (616) 252-7200
DR. TRISTAN J WORTHINGTON DO
Family Medicine
5900 BYRON CENTER AVE SW
WYOMING, MI 49519
Kent County (616) 252-7200
MRS. KELLY ANN MURPHY DNP, FNP-C
Nurse Practitioner (Family)
5900 BYRON CENTER AVE SW
WYOMING, MI 49519
Kent County (616) 252-3900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tony Joo's NPI number?

The NPI number for Tony Joo is 1053168716. It was assigned to this individual provider in the NPPES registry on May 1, 2024.

Where is Tony Joo located?

Tony Joo practices at 5900 Byron Center Ave SW, Wyoming, MI 49519. The listed phone number is (616) 252-7200.

What is Tony Joo's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Tony Joo enrolled in Medicare?

Yes. Tony Joo is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Tony Joo was last updated on May 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.