Provider Demographics
NPI:1568482289
Name:YOON, JIYOUNG (OD)
Entity Type:Individual
Prefix:
First Name:JIYOUNG
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JIYOUNG
Other - Middle Name:
Other - Last Name:YOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3409 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1049
Mailing Address - Country:US
Mailing Address - Phone:718-231-9000
Mailing Address - Fax:718-405-9626
Practice Address - Street 1:3409 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1049
Practice Address - Country:US
Practice Address - Phone:718-231-9000
Practice Address - Fax:718-405-9626
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006830152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02956738Medicaid
NY02956738Medicaid