MEDICARE: DR. MYUNG KIL JEON M.D.

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	208D00000X	General Practice Physician	20482	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750342473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYUNG KIL JEON M.D.

Provider Business Mailing Address
First Line	:	1006 US HIGHWAY 64 E
Second Line	:	PO BOX 707
City	:	PLYMOUTH
State	:	NC
Zip	:	27962-9215
Country	:	US
Telephone Number	:	252-793-5073
Fax Number	:	252-793-3278

Provider Business Practice Location Address
First Line	:	1006 US HIGHWAY 64 E
Second Line	:
City	:	PLYMOUTH
State	:	NC
Zip	:	27962-9215
Country	:	US
Telephone Number	:	252-793-5073
Fax Number	:	252-793-3278

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	04/24/2013

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