Provider Demographics
NPI:1265598759
Name:MYUNG, JOON MO (MD)
Entity type:Individual
Prefix:
First Name:JOON
Middle Name:MO
Last Name:MYUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15408 NORTHERN BLVD
Mailing Address - Street 2:SUITE 2K
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5040
Mailing Address - Country:US
Mailing Address - Phone:718-445-0200
Mailing Address - Fax:718-445-0226
Practice Address - Street 1:15408 NORTHERN BLVD
Practice Address - Street 2:SUITE 2K
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5040
Practice Address - Country:US
Practice Address - Phone:718-445-0200
Practice Address - Fax:718-445-0200
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH84164207RG0100X
NY7048348207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology