MEDICARE: DR. ALEXANDER DU YAPHOCKUN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	207414	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548357569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER DU YAPHOCKUN MD

Provider Business Mailing Address
First Line	:	7901 BROADWAY
Second Line	:	MANAGED CARE, D1-01
City	:	ELMHURST
State	:	NY
Zip	:	11373-1329
Country	:	US
Telephone Number	:	718-334-1921
Fax Number	:	718-334-3432

Provider Business Practice Location Address
First Line	:	3433 JUNCTION BLVD
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-3828
Country	:	US
Telephone Number	:	718-334-6150
Fax Number	:	718-334-6171

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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