Healthcare Provider Details

I. General information

NPI: 1093168833
Provider Name (Legal Business Name): ANNA JUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA PAE

II. Dates (important events)

Enumeration Date: 07/17/2016
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVE
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

630 W 168TH ST # 4
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 646-317-5077
  • Fax: 212-305-8112
Mailing address:
  • Phone: 646-317-5077
  • Fax: 212-305-8112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341518
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number703543-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: