MEDICARE: JAE EUN JEONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1184254138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAE EUN JEONG

Provider Business Mailing Address
First Line	:	8993 W FLAMINGO RD STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-0440
Country	:	US
Telephone Number	:	702-739-9919
Fax Number	:

Provider Business Practice Location Address
First Line	:	8993 W FLAMINGO RD STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-0440
Country	:	US
Telephone Number	:	702-739-9919
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2020
Last Update Date	:	01/17/2020

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Directions to “ JAE EUN JEONG ” Practice Location

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