Healthcare Provider Details

I. General information

NPI: 1689581647
Provider Name (Legal Business Name): YURI N/A JUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 GODWIN AVE
MIDLAND PARK NJ
07432-1539
US

IV. Provider business mailing address

223 LINCOLN AVE
RIDGEWOOD NJ
07450-4901
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-3838
  • Fax:
Mailing address:
  • Phone: 281-740-8107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: