Healthcare Provider Details

I. General information

NPI: 1306731021
Provider Name (Legal Business Name): MR. HANSUNG JEON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 HEMPSTEAD TPKE
EAST MEADOW NY
11554-1712
US

IV. Provider business mailing address

19 MILLER BLVD
SYOSSET NY
11791-3511
US

V. Phone/Fax

Practice location:
  • Phone: 929-401-7186
  • Fax:
Mailing address:
  • Phone: 929-401-7186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007752
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: