Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MA053606 | NJ |
NPI | 1013077874 |
---|---|
Provider Name | Haenam Yun |
First Address | Palisades Park, NJ 07650-2723 |
Second Address | Palisades Park, NJ 07650-2723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F91801 | (02) |