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General NPI Number Information
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NPI Number | 1033607932
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Entity Type | Individual
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Provider Name | YONG NAM JEON DNP, CRNP, AGNP-C
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Gender | Male
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 11/10/2024
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Provider Practice Location Address
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Address Line | 50 W EDMONSTON DR STE 202
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City | ROCKVILLE
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State | MD
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Zip | 20852-1249
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Country | US
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Telephone | 301-762-0788
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Fax |
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Provider Business Mailing Address
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Address Line | 50 W EDMONSTON DR STE 202
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City | ROCKVILLE
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State | MD
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Zip | 20852-1249
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Country | US
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Telephone | 301-762-0788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | R207262
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | R207262
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R207262
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License Number State | MD
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