Basic Information
Provider Information
NPI: 1336673813
EntityType: 2
ReplacementNPI:  
OrganizationName: NYU LANGONE MEDICAL CENTER
LastName:  
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Credential:  
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Mailing Information
Address1: 17508 66TH AVENUE CT E
Address2:  
City: PUYALLUP
State: WA
PostalCode: 983752321
CountryCode: US
TelephoneNumber: 2535718112
FaxNumber:  
Practice Location
Address1: 550 1ST AVE
Address2:  
City: NEW YORK
State: NY
PostalCode: 100166402
CountryCode: US
TelephoneNumber: 2122635506
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/12/2017
LastUpdateDate: 04/12/2017
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: SHIN
AuthorizedOfficialFirstName: YOON
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AuthorizedOfficialTitleorPosition: RESIDENT
AuthorizedOfficialTelephone: 2535718112
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X  Y HospitalsGeneral Acute Care Hospital 

No ID Information.


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