Healthcare Provider Details

I. General information

NPI: 1538887971
Provider Name (Legal Business Name): CHUL HEE JUSTIN JOHNG FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6830 ANDERSON ST
SHAWNEE KS
66226-3101
US

IV. Provider business mailing address

9106 W 97TH ST
OVERLAND PARK KS
66212-5041
US

V. Phone/Fax

Practice location:
  • Phone: 816-922-2750
  • Fax: 816-922-3399
Mailing address:
  • Phone: 281-413-2755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number089401-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number129041
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: