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1154124097 NPI number — JUSTIN MINHO JEONG

NPI Number: 1154124097
Health Care Provider/Practitioner: JUSTIN MINHO JEONG

Information about “1154124097” NPI (JUSTIN MINHO JEONG) exists in 1154124097 in HTML format HTML  |  1154124097 in plain Text format TXT  |  1154124097 in PDF (Portable Document Format) PDF  |  1154124097 in an XML format XML  formats.

NPI Number : 1154124097 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154124097",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JEONG",
    "FirstName": "JUSTIN",
    "MiddleName": "MINHO",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1100 MEREDITH LN APT 523",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PLANO",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75093-4668",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "945-308-9344",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2801 N CENTRAL EXPY # 1150",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75204-2642",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "972-702-0300",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/28/2025",
    "LastUpdateDate": "03/28/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2355S0801X",
        "TaxonomyName": "Speech-Language Assistant",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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