Provider Demographics
NPI:1104141720
Name:YUN, SONI (PMHNP-BC, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:SONI
Middle Name:
Last Name:YUN
Suffix:
Gender:F
Credentials:PMHNP-BC, AGPCNP-BC
Other - Prefix:
Other - First Name:SUNG AE
Other - Middle Name:
Other - Last Name:YOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:500 SAINT JOHNS PL
Mailing Address - Street 2:APT 5 R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5452
Mailing Address - Country:US
Mailing Address - Phone:917-774-6078
Mailing Address - Fax:
Practice Address - Street 1:104 W 40TH ST STE 416
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-3617
Practice Address - Country:US
Practice Address - Phone:212-369-6757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-108205163W00000X
NY622305163W00000X
HIAPRN-3759363LA2200X, 363LG0600X, 363LP0808X
NYF307651363LA2200X, 363LG0600X
NYF403817363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02386450Medicaid