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General NPI Number Information
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NPI Number | 1972235646
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Entity Type | Organization
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Legal Business Name | NYNOS P.C.
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 15814 NORTHERN BLVD ML6
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City | FLUSHING
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State | NY
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Zip | 11358-1135
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Country | US
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Telephone | 919-428-1621
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Fax |
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Provider Business Mailing Address
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Address Line | 15814 NORTHERN BLVD STE ML06
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City | FLUSHING
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State | NY
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Zip | 11358
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Country | US
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Telephone | 718-799-0302
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BOKKWAN JUN
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Credential | MD, PHD
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Telephone | 919-428-1621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0109X
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Taxonomy Name | Neuro-ophthalmology Physician
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License Number |
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License Number State |
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