Provider Demographics
NPI:1780922591
Name:YOON, HYUN JONG (DPT)
Entity type:Individual
Prefix:
First Name:HYUN JONG
Middle Name:
Last Name:YOON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215-19 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2114
Mailing Address - Country:US
Mailing Address - Phone:718-229-0707
Mailing Address - Fax:718-229-0547
Practice Address - Street 1:215-19 39TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2114
Practice Address - Country:US
Practice Address - Phone:718-229-0707
Practice Address - Fax:718-229-0547
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0345322251X0800X
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03757971Medicaid
NYA100092374OtherMEDICARE
NY96712Medicare PIN