Healthcare Provider Details

I. General information

NPI: 1952190860
Provider Name (Legal Business Name): JOANN KYUNG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 47TH RD
LONG ISLAND CITY NY
11101-5513
US

IV. Provider business mailing address

3146 31ST ST FL 2
ASTORIA NY
11106-2531
US

V. Phone/Fax

Practice location:
  • Phone: 718-233-2527
  • Fax: 718-355-9717
Mailing address:
  • Phone: 917-478-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number356713
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: