Healthcare Provider Details

I. General information

NPI: 1457563355
Provider Name (Legal Business Name): A.H.JUNG & C.S.LEE MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4018 MURRAY ST
FLUSHING NY
11354-4934
US

IV. Provider business mailing address

4018 MURRAY ST
FLUSHING NY
11354-4934
US

V. Phone/Fax

Practice location:
  • Phone: 718-461-6464
  • Fax: 718-939-6464
Mailing address:
  • Phone: 718-461-6464
  • Fax: 718-939-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number182552
License Number StateNY

VIII. Authorized Official

Name: ANTHONY HIGUK JUNG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-461-6464