Provider Demographics
NPI:1104700616
Name:JOO, SUNGHYE
Entity type:Individual
Prefix:
First Name:SUNGHYE
Middle Name:
Last Name:JOO
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 1:14454 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3669
Mailing Address - Country:US
Mailing Address - Phone:347-567-1767
Mailing Address - Fax:
Practice Address - Street 1:24825 NORTHERN BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1280
Practice Address - Country:US
Practice Address - Phone:347-567-1767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025877225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist