Individual ProviderMinjung JiNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2015 Grand Concourse, Bronx, NY 10453-4303(718) 299-7295(718) 618-0401PECOS EnrollmentBased on the most recent information from CMS, provider Minjung Ji is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1194275545Provider TypeIndividualFull NameJi, MinjungTitleMs.GenderFemaleSole ProprietorNoEnumeration Date10/10/2016Last Updated10/10/2016Contact InformationPractice LocationPractice Address2015 Grand Concourse, Bronx, NY 10453-4303Phone(718) 299-7295Fax(718) 299-6797Mailing LocationMailing Address3198 Grand Concourse, Bronx, NY 10458-1000Phone(718) 618-0401Fax(718) 795-4394Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseF340142New York