Provider Demographics
NPI:1972029387
Name:CHO, JUNG YEON (RPH)
Entity Type:Individual
Prefix:
First Name:JUNG YEON
Middle Name:
Last Name:CHO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4637 216TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3452
Mailing Address - Country:US
Mailing Address - Phone:516-312-2583
Mailing Address - Fax:
Practice Address - Street 1:2926 UNION ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2201
Practice Address - Country:US
Practice Address - Phone:718-359-3373
Practice Address - Fax:718-321-8647
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist