Provider Demographics
NPI:1730458498
Name:HEALTH CORNER MEDICAL PC
Entity Type:Organization
Organization Name:HEALTH CORNER MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEA
Authorized Official - Middle Name:HYUN
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-334-0001
Mailing Address - Street 1:9301 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7943
Mailing Address - Country:US
Mailing Address - Phone:718-334-0001
Mailing Address - Fax:718-334-0093
Practice Address - Street 1:9301 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7943
Practice Address - Country:US
Practice Address - Phone:718-334-0001
Practice Address - Fax:718-334-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229848207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02658611Medicaid
NYI15485Medicare UPIN