Provider Demographics
NPI:1750634911
Name:P & I DREAM
Entity Type:Organization
Organization Name:P & I DREAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:GEUN
Authorized Official - Last Name:HYUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-321-3210
Mailing Address - Street 1:15301 NORTHERN BLVD
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5035
Mailing Address - Country:US
Mailing Address - Phone:718-321-3210
Mailing Address - Fax:
Practice Address - Street 1:15301 NORTHERN BLVD
Practice Address - Street 2:SUITE 2D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5035
Practice Address - Country:US
Practice Address - Phone:718-321-3210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241219207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03302792Medicaid