Healthcare Provider Details

I. General information

NPI: 1427301902
Provider Name (Legal Business Name): YUNKYOUNG JEONG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2012
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 150TH PL
FLUSHING NY
11354-4922
US

IV. Provider business mailing address

3502 150TH PL
FLUSHING NY
11354-4922
US

V. Phone/Fax

Practice location:
  • Phone: 347-368-6691
  • Fax: 929-999-5729
Mailing address:
  • Phone: 347-368-6691
  • Fax: 929-999-5729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF306229
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number7973933
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: