Provider Demographics
NPI:1053991646
Name:YUN, CATHERINE ROSE
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ROSE
Last Name:YUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HIGHWAY 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6423
Mailing Address - Country:US
Mailing Address - Phone:732-557-2604
Mailing Address - Fax:
Practice Address - Street 1:1810 GRAND CANAL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8110
Practice Address - Country:US
Practice Address - Phone:209-952-1612
Practice Address - Fax:209-952-1613
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE6144213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery