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NPI Code Detail

MEDICARE: YEONG-KEUN JEONG

MEDICARE: YEONG-KEUN 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1497208037
Entity Type Code : Individual
Provider Name (Legal Business Name) : YEONG-KEUN JEONG
Provider Business Mailing Address
First Line : 4800 MEADOWS RD STE 300
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-5277
Country : US
Telephone Number : 503-309-9221
Fax Number :
Provider Business Practice Location Address
First Line : 4800 MEADOWS RD STE 300
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-5277
Country : US
Telephone Number : 971-201-1720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2016
Last Update Date : 07/23/2021

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Directions to “ YEONG-KEUN JEONG ” Practice Location

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