Provider Demographics
NPI:1770032344
Name:BYUN, JUNGMIN (RN)
Entity Type:Individual
Prefix:
First Name:JUNGMIN
Middle Name:
Last Name:BYUN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 28TH AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3040
Mailing Address - Country:US
Mailing Address - Phone:816-868-6184
Mailing Address - Fax:
Practice Address - Street 1:2318 28TH AVE APT 1F
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3040
Practice Address - Country:US
Practice Address - Phone:816-868-6184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY527369163WS0200X
MO2010011393163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool