Healthcare Provider Details

I. General information

NPI: 1932949120
Provider Name (Legal Business Name): SINHAE JEONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 10/02/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE SUITE 245
LANSING MI
48912
US

IV. Provider business mailing address

1200 E MICHIGAN AVE SUITE 245
LANSING MI
48912
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5783
  • Fax:
Mailing address:
  • Phone: 517-364-5710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351052739
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: