Healthcare Provider Details

I. General information

NPI: 1417474362
Provider Name (Legal Business Name): SEOK YOON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 UNION ST
FLUSHING NY
11354-4118
US

IV. Provider business mailing address

3334 28TH ST APT 1B
ASTORIA NY
11106-3444
US

V. Phone/Fax

Practice location:
  • Phone: 718-321-2526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number070471
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPI45598
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: