Provider Demographics
NPI:1043457328
Name:YOONG, JENNIFER (JENNIFER YOONG)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:YOONG
Suffix:
Gender:F
Credentials:JENNIFER YOONG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8916 OPPORTUNITY DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5153
Mailing Address - Country:US
Mailing Address - Phone:505-450-8611
Mailing Address - Fax:
Practice Address - Street 1:6250 PASEO DEL NORTE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1712
Practice Address - Country:US
Practice Address - Phone:505-217-2392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist