Provider Demographics
NPI:1598174666
Name:MODEN MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:MODEN MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HOJUNG
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:YOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-822-1184
Mailing Address - Street 1:PO BOX 583538
Mailing Address - Street 2:PMB 93791
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55458-3538
Mailing Address - Country:US
Mailing Address - Phone:888-822-1184
Mailing Address - Fax:888-877-3676
Practice Address - Street 1:100 ROBERT AVE N APT 101
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:MN
Practice Address - Zip Code:56144-1220
Practice Address - Country:US
Practice Address - Phone:888-822-1184
Practice Address - Fax:888-877-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty