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General NPI Number Information
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NPI Number | 1124381983
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Entity Type | Organization
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Legal Business Name | JUN YANG KIDNEY CARE PC
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 13443 MAPLE AVE STE C1D
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City | FLUSHING
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State | NY
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Zip | 11355-4527
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Country | US
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Telephone | 718-886-7588
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Fax | 646-863-4210
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Provider Business Mailing Address
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Address Line | 14329 BARCLAY AVE APT 5D
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City | FLUSHING
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State | NY
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Zip | 11355-1978
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Country | US
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Telephone | 347-296-5922
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Fax | 646-863-4210
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUN YANG
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Credential | MD
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Telephone | 347-296-5922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 257366
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License Number State | NY
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