Healthcare Provider Details

I. General information

NPI: 1831458322
Provider Name (Legal Business Name): JACQUELINE JUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SUNSHINE COTTAGE RD
VALHALLA NY
10595-1524
US

IV. Provider business mailing address

1364 CLIFTON RD NE BG20
ATLANTA GA
30332-0001
US

V. Phone/Fax

Practice location:
  • Phone: 914-594-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA153590
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number94862
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: