Healthcare Provider Details

I. General information

NPI: 1629398680
Provider Name (Legal Business Name): KAMYU YEUNG CDN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 62ND ST
BROOKLYN NY
11204-3027
US

IV. Provider business mailing address

1926 62ND ST
BROOKLYN NY
11204-3027
US

V. Phone/Fax

Practice location:
  • Phone: 347-416-3728
  • Fax:
Mailing address:
  • Phone: 347-416-3728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number006505
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: