Healthcare Provider Details

I. General information

NPI: 1386550754
Provider Name (Legal Business Name): INGEON JUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 W SANTA FE ST
OLATHE KS
66061-3115
US

IV. Provider business mailing address

9001 METCALF AVE APT 4021
OVERLAND PARK KS
66212-2691
US

V. Phone/Fax

Practice location:
  • Phone: 913-764-5858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-114002
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: