Healthcare Provider Details

I. General information

NPI: 1528487089
Provider Name (Legal Business Name): JOHN K BYUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NICOLLS RD
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

PO BOX 419033
BOSTON MA
02241-9033
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2325
  • Fax:
Mailing address:
  • Phone: 631-444-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number345605
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number25MA10129400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberC197416
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number281113
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: