Provider Demographics
NPI:1568943934
Name:JUNG, IL YOUNG (SLP-CF)
Entity Type:Individual
Prefix:MS
First Name:IL YOUNG
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 208TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1120
Mailing Address - Country:US
Mailing Address - Phone:718-688-9772
Mailing Address - Fax:
Practice Address - Street 1:622 3RD AVE FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6723
Practice Address - Country:US
Practice Address - Phone:212-683-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program