Provider Demographics
NPI:1033495643
Name:SON, JUNG YOEN
Entity Type:Individual
Prefix:
First Name:JUNG YOEN
Middle Name:
Last Name:SON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2274 GOLFVIEW DR
Mailing Address - Street 2:APT 202
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3848
Mailing Address - Country:US
Mailing Address - Phone:734-717-3343
Mailing Address - Fax:
Practice Address - Street 1:2274 GOLFVIEW DR
Practice Address - Street 2:APT 202
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3848
Practice Address - Country:US
Practice Address - Phone:734-717-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704265166363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health