Provider Demographics
NPI:1154679090
Name:YUN, DAVID KIN (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KIN
Last Name:YUN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1023
Mailing Address - Country:US
Mailing Address - Phone:917-440-7194
Mailing Address - Fax:
Practice Address - Street 1:6142 186TH ST STE 652
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2711
Practice Address - Country:US
Practice Address - Phone:646-653-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
NY266396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400718779Medicaid
NY390200000XOtherPECONIC BAY MEDICAL CENTER