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General NPI Number Information
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NPI Number | 1316333537
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Entity Type | Individual
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Provider Name | KOREY YNGSTROM
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Gender | Male
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 1850 TOWN CENTER PKWY STE 400
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City | RESTON
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State | VA
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Zip | 20190-3300
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Country | US
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Telephone | 703-810-5202
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Fax |
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Provider Business Mailing Address
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Address Line | 7544 JACQUE RD.
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City | HUDSON
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State | FL
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Zip | 34667
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0102208649
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | OS17639
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License Number State | FL
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