Healthcare Provider Details

I. General information

NPI: 1679771935
Provider Name (Legal Business Name): SORA YOON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 N BEERS ST
HOLMDEL NJ
07733-1514
US

IV. Provider business mailing address

PO BOX 441
ORADELL NJ
07649-0441
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-1205
  • Fax: 201-342-1259
Mailing address:
  • Phone: 201-342-1205
  • Fax: 201-342-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA08252700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: