Provider Demographics
NPI:1245847953
Name:JUNG, HYUN KYUNG
Entity type:Individual
Prefix:
First Name:HYUN KYUNG
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 1:4037 77TH ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1104
Mailing Address - Country:US
Mailing Address - Phone:619-208-3955
Mailing Address - Fax:
Practice Address - Street 1:84 LINDEN BLVD BSMT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3301
Practice Address - Country:US
Practice Address - Phone:347-252-6215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2021-01-22
Deactivation Date:2020-09-26
Deactivation Code:
Reactivation Date:2021-01-22
Provider Licenses
StateLicense IDTaxonomies
NY044104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty