Provider Demographics
NPI:1811395304
Name:TUNG, SOYOUNG LEE
Entity Type:Individual
Prefix:
First Name:SOYOUNG
Middle Name:LEE
Last Name:TUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24916 60TH AVE
Mailing Address - Street 2:1F
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2032
Mailing Address - Country:US
Mailing Address - Phone:201-620-1301
Mailing Address - Fax:
Practice Address - Street 1:249-16 60TH AVE
Practice Address - Street 2:1F
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362
Practice Address - Country:US
Practice Address - Phone:201-620-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist