Provider Demographics
NPI:1699157263
Name:YOON, YISUK (NP)
Entity type:Individual
Prefix:
First Name:YISUK
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21975 75TH AVE.
Mailing Address - Street 2:FL 2ND
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3044
Mailing Address - Country:US
Mailing Address - Phone:646-637-8552
Mailing Address - Fax:
Practice Address - Street 1:21975 75TH AVE.
Practice Address - Street 2:FL 2ND
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3044
Practice Address - Country:US
Practice Address - Phone:646-637-8552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306946-1364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical