Provider Demographics
NPI:1770580235
Name:BRUININGS, YEAHSEON CHOI (MD)
Entity type:Individual
Prefix:
First Name:YEAHSEON
Middle Name:CHOI
Last Name:BRUININGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3438 BELL BLVD
Mailing Address - Street 2:PH FLOOR 5
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1730
Mailing Address - Country:US
Mailing Address - Phone:718-360-5768
Mailing Address - Fax:718-224-5885
Practice Address - Street 1:3438 BELL BLVD
Practice Address - Street 2:PH FLOOR 5
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1730
Practice Address - Country:US
Practice Address - Phone:718-360-5768
Practice Address - Fax:718-224-5885
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02405338Medicaid
NY06630GMedicare ID - Type Unspecified
NY02405338Medicaid