Provider Demographics
NPI:1790773612
Name:YUN, ERIC YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:YOUNG
Last Name:YUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 GOOD LUCK RD
Mailing Address - Street 2:STE 110
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3502
Mailing Address - Country:US
Mailing Address - Phone:240-542-3034
Mailing Address - Fax:
Practice Address - Street 1:8116 GOOD LUCK RD
Practice Address - Street 2:STE 110
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3502
Practice Address - Country:US
Practice Address - Phone:240-542-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD114202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A947280Medicaid
1988OtherNHPRI
3708002OtherAETNA
MA2082560Medicaid
CAGR0106039Medicaid
P00140795OtherRAILROAD MEDICARE
CAWA94728EMedicare PIN
CA00A947283Medicare PIN
I10805Medicare UPIN
CAWA94728CMedicare PIN
CAWA94728JMedicare PIN
1988OtherNHPRI
CAWA94728GMedicare PIN
CA00A947284Medicare PIN
P00140795OtherRAILROAD MEDICARE
CAWA94728DMedicare PIN
CAWA94728HMedicare PIN
CAWA94728IMedicare PIN
CA00A947281Medicare PIN
CAWA94728AMedicare PIN
CAAN901ZMedicare PIN
CAGR0106039Medicaid
CAWA947281Medicare PIN
CATP051AMedicare PIN
CA00A947282Medicare PIN