Healthcare Provider Details

I. General information

NPI: 1013402668
Provider Name (Legal Business Name): YUJIN HONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 09/04/2021
Certification Date: 09/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 MAIN ST
BRIDGEPORT CT
06606-1846
US

IV. Provider business mailing address

34 COMMODORE AVE
SHELTON CT
06484-5919
US

V. Phone/Fax

Practice location:
  • Phone: 203-372-6538
  • Fax: 844-411-6470
Mailing address:
  • Phone: 973-641-8648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0014229
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: