Provider Demographics
NPI:1285684357
Name:NAMKOONG, SEUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:SEUNG
Middle Name:
Last Name:NAMKOONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 TAYLOR RD S
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2316
Mailing Address - Country:US
Mailing Address - Phone:973-467-9568
Mailing Address - Fax:201-653-5493
Practice Address - Street 1:206 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1104
Practice Address - Country:US
Practice Address - Phone:201-653-5493
Practice Address - Fax:201-653-5493
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ32603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3772705Medicaid
NJFO9593OtherHEALTHNET
NJ116589OtherAETNA
NJC53657Medicare UPIN
NJ3772705Medicaid