Active NPI
Youngsoon An
- Adult Health Nurse Practitioner
- New York, NY
National Provider Identifier
1174821128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- F305442
- Practice address
- 10 Union SQ E
Suite 4G
New York, NY 10003-3314 - Phone
- (201) 866-9320
- NPI assigned
- Feb 28, 2011
- Last updated
- Jan 31, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | F305442 | NY | Primary |
Addresses
Primary practice location
10 Union SQ E
Suite 4G
New York, NY 10003-3314
Mailing address
254 Forest Ave
Glen Ridge, NJ 07028-1727
Phone (718) 406-6705
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211018002907 | NY | Order and Referring Only - Nurse Practitioner | 7517365802 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F305442 | NY | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359590400000",
"number": "1174821128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "254 FOREST AVE",
"city": "GLEN RIDGE",
"state": "NJ",
"postal_code": "070281727",
"telephone_number": "718-406-6705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 UNION SQ E",
"address_2": "SUITE 4G",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100033314",
"telephone_number": "201-866-9320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AN",
"first_name": "YOUNGSOON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-02-28",
"last_updated": "2013-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "NY",
"license": "F305442",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; 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.