Provider Demographics
NPI:1649338484
Name:YUN, JEAN SHIM (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:SHIM
Last Name:YUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 CANAL ST
Mailing Address - Street 2:SUITE 5001
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3501
Mailing Address - Country:US
Mailing Address - Phone:212-925-2121
Mailing Address - Fax:212-925-2102
Practice Address - Street 1:254 CANAL ST
Practice Address - Street 2:SUITE 5001
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3501
Practice Address - Country:US
Practice Address - Phone:212-925-2121
Practice Address - Fax:212-925-2102
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235772207X00000X
NJ25MA069134207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3060932OtherOXFORD
NJ0055387Medicaid
NYP3060932OtherOXFORD
NJH98958Medicare UPIN
NY663G61Medicare ID - Type Unspecified