Healthcare Provider Details

I. General information

NPI: 1033109376
Provider Name (Legal Business Name): JUNG H YOUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FRANKLIN AVE SUITE 300
GARDEN CITY NY
11530-2926
US

IV. Provider business mailing address

1000 FRANKLIN AVE SUITE 300
GARDEN CITY NY
11530-2926
US

V. Phone/Fax

Practice location:
  • Phone: 516-248-6868
  • Fax: 516-248-6841
Mailing address:
  • Phone: 516-248-6868
  • Fax: 516-248-6841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1917201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: