Healthcare Provider Details

I. General information

NPI: 1578990669
Provider Name (Legal Business Name): JOSEPH SAE HYUN PYUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 5TH AVE #2FF
BROOKLYN NY
11215-4812
US

IV. Provider business mailing address

506 5TH AVE #2FF
BROOKLYN NY
11215-4812
US

V. Phone/Fax

Practice location:
  • Phone: 212-882-1110
  • Fax: 212-882-1120
Mailing address:
  • Phone: 212-882-1110
  • Fax: 212-882-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number282853
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number25MA09868400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: