Provider Demographics
NPI:1295113199
Name:BYUN, JI YOUNG (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:JI YOUNG
Middle Name:
Last Name:BYUN
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13060 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-1200
Mailing Address - Country:US
Mailing Address - Phone:623-499-9100
Mailing Address - Fax:623-267-5060
Practice Address - Street 1:13060 W BELL RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-1200
Practice Address - Country:US
Practice Address - Phone:623-499-9100
Practice Address - Fax:623-267-5060
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10293363LA2100X
TXAP 127038363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner