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General NPI Number Information
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NPI Number | 1962423939
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Entity Type | Organization
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Legal Business Name | YONG W JEONG
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 2552 ROYAL LN
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City | DALLAS
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State | TX
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Zip | 75229-3417
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Country | US
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Telephone | 972-247-5670
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Fax | 972-247-5670
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Provider Business Mailing Address
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Address Line | 2552 ROYAL LN
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City | DALLAS
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State | TX
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Zip | 75229-3417
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Country | US
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Telephone | 972-247-5670
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Fax |
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Authorized Official
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Title or Position | RPH LAC PHD
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Name | GREG JEONG
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Credential |
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Telephone | 972-247-5670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 11564
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License Number State | TX
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