Healthcare Provider Details

I. General information

NPI: 1104387927
Provider Name (Legal Business Name): ANDREW JUNG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
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:
Mailing address:
  • Phone: 718-461-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number316065
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number316065
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: