Provider Demographics
NPI:1942639745
Name:JUNG, SOH RA
Entity Type:Individual
Prefix:
First Name:SOH RA
Middle Name:
Last Name:JUNG
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 1:310 94T ST.
Mailing Address - Street 2:APT. 618
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6966
Mailing Address - Country:US
Mailing Address - Phone:914-338-4449
Mailing Address - Fax:
Practice Address - Street 1:310 94TH ST
Practice Address - Street 2:APT. 618
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6952
Practice Address - Country:US
Practice Address - Phone:914-338-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY606922163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse