Basic Information
Provider Information
NPI: 1629124706
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YOON
FirstName: CECILIA
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 53 W 23RD ST FL 6
Address2:  
City: NEW YORK
State: NY
PostalCode: 100104237
CountryCode: US
TelephoneNumber: 2127467200
FaxNumber: 2127467166
Practice Location
Address1: 53 W 23RD ST FL 6
Address2:  
City: NEW YORK
State: NY
PostalCode: 100104237
CountryCode: US
TelephoneNumber: 2127467200
FaxNumber: 2127467166
Other Information
ProviderEnumerationDate: 01/25/2007
LastUpdateDate: 08/21/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200X204135NYY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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