Provider Demographics
NPI:1619343324
Name:YOUN, YOUNGJUN
Entity Type:Individual
Prefix:
First Name:YOUNGJUN
Middle Name:
Last Name:YOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 165TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2005
Mailing Address - Country:US
Mailing Address - Phone:646-413-2200
Mailing Address - Fax:
Practice Address - Street 1:3603 165TH ST FL 3
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2005
Practice Address - Country:US
Practice Address - Phone:646-413-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005480171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherNO FAULT, WORKERS COMP, OTHER INSURANCE COMPANY