Healthcare Provider Details

I. General information

NPI: 1467774729
Provider Name (Legal Business Name): JANICE YOONMI JEON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANICE YOONMI LEE M.D.

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S. GREENE STREET DEPT OF RADIOLOGY
BALTIMORE MD
21201
US

IV. Provider business mailing address

8030 CRIANZA PL APT. 242
VIENNA VA
22182-4090
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-3477
  • Fax:
Mailing address:
  • Phone: 917-886-1884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0073372
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: