Provider Demographics
NPI:1407050446
Name:YOON, SEI OUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:SEI OUNG
Middle Name:
Last Name:YOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:SEI OUNG
Other - Last Name:YOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100-25 QUEENS BOULEVARD
Mailing Address - Street 2:SUITE #1CC
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-544-9525
Mailing Address - Fax:718-544-9019
Practice Address - Street 1:100-25 QUEENS BOULEVARD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-544-9525
Practice Address - Fax:718-544-9019
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126733208800000X
NJ31568208800000X
PA17730E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00248366Medicaid
C67082Medicare UPIN
93626Medicare ID - Type Unspecified