Healthcare Provider Details

I. General information

NPI: 1619803541
Provider Name (Legal Business Name): MR. SUYOUNG YUN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 10TH ST APT 1
FORT LEE NJ
07024-2190
US

IV. Provider business mailing address

1522 10TH ST APT 1
FORT LEE NJ
07024-2190
US

V. Phone/Fax

Practice location:
  • Phone: 201-981-9942
  • Fax:
Mailing address:
  • Phone: 201-981-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007942
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00183400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: