Provider Demographics
NPI:1841689965
Name:CHANG, YU YUN
Entity type:Individual
Prefix:
First Name:YU YUN
Middle Name:
Last Name:CHANG
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 1:6110 ALDERTON ST
Mailing Address - Street 2:APT 6A
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6110 ALDERTON ST
Practice Address - Street 2:APT 6A
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2743
Practice Address - Country:US
Practice Address - Phone:678-492-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist