Provider Demographics
NPI:1780069799
Name:BAK, SANGYOUN
Entity type:Individual
Prefix:DR
First Name:SANGYOUN
Middle Name:
Last Name:BAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 BEEBE RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2229
Mailing Address - Country:US
Mailing Address - Phone:516-581-1959
Mailing Address - Fax:
Practice Address - Street 1:149 BEEBE RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2229
Practice Address - Country:US
Practice Address - Phone:516-581-1959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist