Provider Demographics
NPI:1639576325
Name:KOOK, JOONHYE
Entity Type:Individual
Prefix:
First Name:JOONHYE
Middle Name:
Last Name:KOOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 LINWOOD AVE
Mailing Address - Street 2:APT 3D
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3864
Mailing Address - Country:US
Mailing Address - Phone:304-276-7893
Mailing Address - Fax:
Practice Address - Street 1:2350 LINWOOD AVE
Practice Address - Street 2:APT 3D
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3864
Practice Address - Country:US
Practice Address - Phone:304-276-7893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily