Healthcare Provider Details

I. General information

NPI: 1609458363
Provider Name (Legal Business Name): SHINYEONG JEONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 COLORADO BLVD
DENTON TX
76210-6817
US

IV. Provider business mailing address

3321 COLORADO BLVD
DENTON TX
76210-6817
US

V. Phone/Fax

Practice location:
  • Phone: 940-382-9429
  • Fax: 940-387-2426
Mailing address:
  • Phone: 940-382-9429
  • Fax: 940-387-2426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberW7045
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: