Provider Demographics
NPI:1063882744
Name:CHUNG, YOUNG YOON
Entity type:Individual
Prefix:
First Name:YOUNG YOON
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15119 34TH AVE APT 2J
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3915
Mailing Address - Country:US
Mailing Address - Phone:646-463-1298
Mailing Address - Fax:
Practice Address - Street 1:15119 34TH AVE
Practice Address - Street 2:APT 2J
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3959
Practice Address - Country:US
Practice Address - Phone:646-463-1298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00078400171100000X
NY004011171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MZ00078400OtherNEW JERSEY DEPARTMENT OF EDUCATION
NY004011OtherNEW YORK EDUCATION DEPARTMENT