Provider Demographics
NPI:1639335672
Name:YOUNG AN CHURCH
Entity type:Organization
Organization Name:YOUNG AN CHURCH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:HO
Authorized Official - Last Name:SHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-417-9269
Mailing Address - Street 1:11445 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229
Mailing Address - Country:US
Mailing Address - Phone:214-417-9269
Mailing Address - Fax:972-243-6260
Practice Address - Street 1:11445 EMERALD ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229
Practice Address - Country:US
Practice Address - Phone:214-417-9269
Practice Address - Fax:972-243-6260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUNG AN CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies