Healthcare Provider Details

I. General information

NPI: 1578734448
Provider Name (Legal Business Name): MYUNG KIL JEON, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 US HWY 64 E BLDG # 4
PLYMOUTH NC
27962-9215
US

IV. Provider business mailing address

PO BOX 948
PLYMOUTH NC
27962-0948
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-5073
  • Fax: 252-793-3278
Mailing address:
  • Phone: 252-793-5073
  • Fax: 252-793-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SOOK JEON
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-793-5073