Healthcare Provider Details

I. General information

NPI: 1629998695
Provider Name (Legal Business Name): YONGJIN BYUN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 SUMMIT AVE
JERSEY CITY NJ
07306-3101
US

IV. Provider business mailing address

25 CHRISTOPHER COLUMBUS DR APT 3202
JERSEY CITY NJ
07302-5143
US

V. Phone/Fax

Practice location:
  • Phone: 201-499-1969
  • Fax:
Mailing address:
  • Phone: 914-208-0211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: