Provider Demographics
NPI:1528193596
Name:NAMKOONG, JIN YEON
Entity Type:Individual
Prefix:
First Name:JIN YEON
Middle Name:
Last Name:NAMKOONG
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 1:2525 DOGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4216
Mailing Address - Country:US
Mailing Address - Phone:516-221-1440
Mailing Address - Fax:
Practice Address - Street 1:485 BELLMORE AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4706
Practice Address - Country:US
Practice Address - Phone:516-557-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002798171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist