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General NPI Number Information
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NPI Number | 1679942767
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Entity Type | Individual
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Provider Name | YEONWOO JUNG PHARMD
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Gender | Male
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 3363A BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10031-7403
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Country | US
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Telephone | 212-518-3010
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Fax | 866-280-3150
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Provider Business Mailing Address
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Address Line | 4542 41ST ST APT 1H
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City | SUNNYSIDE
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State | NY
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Zip | 11104-3421
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Country | US
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Telephone | 716-545-6000
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 060713-1
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License Number State | NY
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