Provider Demographics
NPI:1124256581
Name:JUN, BOKKWAN (MD)
Entity type:Individual
Prefix:DR
First Name:BOKKWAN
Middle Name:
Last Name:JUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15814 NORTHERN BLVD
Mailing Address - Street 2:STE ML06
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358
Mailing Address - Country:US
Mailing Address - Phone:718-799-0302
Mailing Address - Fax:718-799-0442
Practice Address - Street 1:15814 NORTHERN BLVD
Practice Address - Street 2:ML6
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1629
Practice Address - Country:US
Practice Address - Phone:919-428-1621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297533207WX0109X
MO1124256581207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05458860Medicaid