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General NPI Number Information
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NPI Number | 1467663872
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Entity Type | Individual
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Provider Name | HONG SUN JEONG MD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 1706 BERGLUND LN
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City | MELBOURNE
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State | FL
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Zip | 32940-6474
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Country | US
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Telephone | 321-421-7525
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Fax | 321-622-6860
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Provider Business Mailing Address
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Address Line | 8095 SPYGLASS HILL RD STE 105
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City | MELBOURNE
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State | FL
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Zip | 32940-8290
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Country | US
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Telephone | 804-677-8956
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME107337
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME107337
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | ME107337
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | ME107337
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License Number State | FL
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