Provider Demographics
NPI:1710090840
Name:YOON, TAEK SANG (MD)
Entity Type:Individual
Prefix:DR
First Name:TAEK
Middle Name:SANG
Last Name:YOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:953 49TH ST
Mailing Address - Street 2:SUITE 511
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2923
Mailing Address - Country:US
Mailing Address - Phone:718-283-8380
Mailing Address - Fax:718-283-7884
Practice Address - Street 1:953 49TH ST
Practice Address - Street 2:SUITE 511
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2923
Practice Address - Country:US
Practice Address - Phone:718-283-8380
Practice Address - Fax:718-283-7884
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY215550207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01793342Medicaid
NY01793342Medicaid
NYG67512Medicare UPIN