Basic Information
| Provider Information | |||||||||
| NPI: | 1477075448 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SORA YOON MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 144 | ||||||||
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| City: | BRIDGETON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083020109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564519395 | ||||||||
| FaxNumber: | 8564518615 | ||||||||
| Practice Location | |||||||||
| Address1: | 1051 W SHERMAN AVE BLDG 2 | ||||||||
| Address2: | |||||||||
| City: | VINELAND | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083606931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564519395 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2017 | ||||||||
| LastUpdateDate: | 07/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | GANDY | ||||||||
| AuthorizedOfficialFirstName: | BETTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING & BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8564519395 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.