Jin Pyun, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

232759 Issued in NY

Practice address

10506 2ND St
Fort Drum, NY 13602

Phone

(315) 772-8443

NPI assigned

Dec 22, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Sound Emergency Medicine PC

  • Emergency Medicine Physician
  • Everett, WA
  • NPI 1114937919
  Medicare reassignment NPD
• Providence Health & Services- Washington

  dba PMG NW Wa

  • General Practice Physician
  • Everett, WA
  • NPI 1124270715
  Medicare reassignment NPD
• Providence Health & Services-Washington

  dba PMG NW WA Cardiology

  • Cardiovascular Disease Physician
  • Everett, WA
  • NPI 1508000449
  NPD
• Providence Health & Services-Wa

  • General Acute Care Hospital
  • Everett, WA
  • NPI 1700037801
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1073599866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 NW VALLEYBROOK DR",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735059525",
            "telephone_number": "917-282-9646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10506 2ND ST",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "13602",
            "telephone_number": "315-772-8443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PYUN",
        "first_name": "JIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "232759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lara Kristina Primak, M.D.
• Ian Nicolas Prins, DMD
• Lisa M Proulx, RN
• Bonita Lynn Pruitt, DDS
• Lorraine Jaconna Pugh, LCSW
• Serajus Salekin Quaderi, DDS
• Julia Radko
• Justin David Rado, PHYSICIAN ASSISTANT
• Mahbuba Rahman, DDS
• Colette Rajner

• Emergency Medicine Physician in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Emergency Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.