Healthcare Provider Details

I. General information

NPI: 1689021289
Provider Name (Legal Business Name): DYJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14218 38TH AVE STE CFD
FLUSHING NY
11354-5554
US

IV. Provider business mailing address

14218 38TH AVE STE CFD
FLUSHING NY
11354-5554
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-2288
  • Fax:
Mailing address:
  • Phone: 718-886-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. DANIEL YUN
Title or Position: OWNER
Credential:
Phone: 718-886-2288