Basic Information
Provider Information
NPI: 1538233804
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUNG
FirstName: YVONNE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: LB# 7550 PO BOX 95000
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191957550
CountryCode: US
TelephoneNumber: 8443621735
FaxNumber: 9732907495
Practice Location
Address1: 73 PARK ST
Address2:  
City: MONTCLAIR
State: NJ
PostalCode: 070422903
CountryCode: US
TelephoneNumber: 9737467375
FaxNumber: 9737466772
Other Information
ProviderEnumerationDate: 11/20/2006
LastUpdateDate: 12/12/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X25MA06989900NJY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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