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General NPI Number Information
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NPI Number | 1972062529
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Entity Type | Individual
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Provider Name | HYEONG JUN JI ATC
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Gender | Male
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Dates
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Enumeration Date | 03/13/2019
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Last Update Date | 03/13/2019
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Provider Practice Location Address
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Address Line | 1 REDMEN ST
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City | ISLIP TERRACE
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State | NY
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Zip | 11752-2805
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Country | US
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Telephone | 646-943-0027
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Fax |
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Provider Business Mailing Address
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Address Line | 5160 VAN KLEECK ST APT 6N
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City | ELMHURST
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State | NY
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Zip | 11373-4216
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Country | US
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Telephone | 646-943-0027
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 003710-1
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License Number State | NY
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