Healthcare Provider Details

I. General information

NPI: 1740345669
Provider Name (Legal Business Name): RAYMOND L YUNG MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 GRAND STREET 6TH FLOOR
NEW YORK NY
10013-4223
US

IV. Provider business mailing address

217 GRAND STREET 6TH FLOOR
NEW YORK NY
10013-4223
US

V. Phone/Fax

Practice location:
  • Phone: 212-625-8069
  • Fax: 212-431-8246
Mailing address:
  • Phone: 212-625-8069
  • Fax: 212-431-8246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number1855781
License Number StateNY

VIII. Authorized Official

Name: DR. RAYMOND L YUNG
Title or Position: PRESIDENT
Credential: MD
Phone: 212-625-8069