Healthcare Provider Details

I. General information

NPI: 1336642198
Provider Name (Legal Business Name): PHILIP SUNGHO YUNE MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2018
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COMMUNITY DR
MANHASSET NY
11030-3815
US

IV. Provider business mailing address

400 COMMUNITY DR
MANHASSET NY
11030-3815
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-4280
  • Fax:
Mailing address:
  • Phone: 516-562-4280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number309323
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: