Healthcare Provider Details

I. General information

NPI: 1598212581
Provider Name (Legal Business Name): YEN UNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BG CRAWFORD F. SAMS HEALTH CLINIC UNIT 45011
APO AP
96343-5011
US

IV. Provider business mailing address

PSC 704 BOX 3309
APO AP
96338-0014
US

V. Phone/Fax

Practice location:
  • Phone: 01181464074127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number2286489
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: