Provider Demographics
NPI:1629187224
Name:KUM, YOUNG CHUN (RPH, LAC)
Entity Type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:CHUN
Last Name:KUM
Suffix:
Gender:M
Credentials:RPH, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 FRASER ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6111
Mailing Address - Country:US
Mailing Address - Phone:718-494-3035
Mailing Address - Fax:
Practice Address - Street 1:1225 GERARD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8001
Practice Address - Country:US
Practice Address - Phone:718-960-2772
Practice Address - Fax:718-960-2628
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001079171100000X
NY036122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered183500000XPharmacy Service ProvidersPharmacist