Healthcare Provider Details

I. General information

NPI: 1205211455
Provider Name (Legal Business Name): ADA YEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 CHARLES AVE
MASSAPEQUA PARK NY
11762-1601
US

IV. Provider business mailing address

358 CHARLES AVE
MASSAPEQUA PARK NY
11762-1601
US

V. Phone/Fax

Practice location:
  • Phone: 516-313-9117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number923344151
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number708897131
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: