Healthcare Provider Details

I. General information

NPI: 1942117981
Provider Name (Legal Business Name): JIYOUNG CHON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 WALKER AVENUE
GREENSBORO NC
27412-0001
US

IV. Provider business mailing address

1007 WALKER AVE
GREENSBORO NC
27403
US

V. Phone/Fax

Practice location:
  • Phone: 336-334-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number307830
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: