Provider Demographics
NPI:1295270585
Name:NAMKOONG, JANE YOUNG (PA)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:YOUNG
Last Name:NAMKOONG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:YOUNG
Other - Last Name:CHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4500 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2205
Mailing Address - Country:US
Mailing Address - Phone:718-670-5766
Mailing Address - Fax:
Practice Address - Street 1:4500 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2205
Practice Address - Country:US
Practice Address - Phone:718-670-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020455-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant