Healthcare Provider Details

I. General information

NPI: 1477075448
Provider Name (Legal Business Name): SORA YOON MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W SHERMAN AVE BLDG 2
VINELAND NJ
08360-6931
US

IV. Provider business mailing address

PO BOX 144
BRIDGETON NJ
08302-0109
US

V. Phone/Fax

Practice location:
  • Phone: 856-451-9395
  • Fax:
Mailing address:
  • Phone: 856-451-9395
  • Fax: 856-451-8615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: BETTY GANDY
Title or Position: CREDENTIALING & BILLING MANAGER
Credential:
Phone: 856-451-9395