Healthcare Provider Details

I. General information

NPI: 1265342992
Provider Name (Legal Business Name): HYO JUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S CENTRAL AVE
VALLEY STREAM NY
11580-5437
US

IV. Provider business mailing address

4025 74TH ST
ELMHURST NY
11373-5634
US

V. Phone/Fax

Practice location:
  • Phone: 718-280-1137
  • Fax: 646-558-7529
Mailing address:
  • Phone: 718-280-1137
  • Fax: 646-558-7528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP127792
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: