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General NPI Number Information
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NPI Number | 1750634911
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Entity Type | Organization
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Legal Business Name | P & I DREAM
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 15301 NORTHERN BLVD SUITE 2D
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City | FLUSHING
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State | NY
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Zip | 11354-5035
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Country | US
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Telephone | 718-321-3210
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Fax |
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Provider Business Mailing Address
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Address Line | 15301 NORTHERN BLVD SUITE 2D
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City | FLUSHING
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State | NY
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Zip | 11354-5035
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Country | US
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Telephone | 718-321-3210
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAE GEUN HYUN
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Credential | MD
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Telephone | 718-321-3210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 241219
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License Number State | NY
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