MEDICARE: YEON SIL SEONG FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F340099	NY

General Provider Information

NPI Number	:	1104298561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEON SIL SEONG FNP

Provider Business Mailing Address
First Line	:	22417A 69TH AVE
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2731
Country	:	US
Telephone Number	:	480-213-3507
Fax Number	:

Provider Business Practice Location Address
First Line	:	22417A 69TH AVE
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2731
Country	:	US
Telephone Number	:	480-213-3507
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/26/2015

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Directions to “ YEON SIL SEONG FNP” Practice Location

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