Healthcare Provider Details

I. General information

NPI: 1073351243
Provider Name (Legal Business Name): MISS JASMINE YEN-BINH NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 BRUCKNER BLVD 6TH FL
BRONX NY
10461
US

IV. Provider business mailing address

5 TUDOR CITY PL APT 1414
NEW YORK NY
10017-6872
US

V. Phone/Fax

Practice location:
  • Phone: 718-823-9227
  • Fax:
Mailing address:
  • Phone: 832-585-4128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number010028
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: