Healthcare Provider Details

I. General information

NPI: 1669676466
Provider Name (Legal Business Name): YEAHSEON BRUININGS MD FAMILY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3438 BELL BLVD PH FLOOR 5
BAYSIDE NY
11361-1730
US

IV. Provider business mailing address

3438 BELL BLVD PH FLOOR 5
BAYSIDE NY
11361-1730
US

V. Phone/Fax

Practice location:
  • Phone: 718-360-5768
  • Fax:
Mailing address:
  • Phone: 718-360-5768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number226709
License Number StateNY

VIII. Authorized Official

Name: DR. YEAHSEON CHOI BRUININGS
Title or Position: MEMBER , PHYSICIAN
Credential: M.D.
Phone: 718-360-5768