Healthcare Provider Details

I. General information

NPI: 1962582817
Provider Name (Legal Business Name): JEANIE HEE-KYUNG CHUNG M.D., PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEE KYUNG LEDDON M.D.

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 RUSH DR
SALIDA CO
81201-9665
US

IV. Provider business mailing address

7300 RANCH ROAD 2222, BUILDING 1, STE 200
AUSTIN TX
78730
US

V. Phone/Fax

Practice location:
  • Phone: 719-539-4600
  • Fax: 719-539-4629
Mailing address:
  • Phone: 512-628-0465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number38765
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberCDRH.0038765
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: