Healthcare Provider Details

I. General information

NPI: 1912023565
Provider Name (Legal Business Name): DAVID JEONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 MASSACHUSETTS AVE NW STE 200
WASHINGTON DC
20016-2004
US

IV. Provider business mailing address

4850 MASSACHUSETTS AVE NW STE 200
WASHINGTON DC
20016-2004
US

V. Phone/Fax

Practice location:
  • Phone: 202-966-5000
  • Fax:
Mailing address:
  • Phone: 202-966-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD60021238
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA12831100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD0070669
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD600003736
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0101278820
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number338468-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: