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NPI Code Detail

MEDICARE: SUE JONG M.D.

MEDICARE: SUE JONG M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianJ4241TX

General Provider Information

NPI Number : 1285636274
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUE JONG M.D.
Provider Business Mailing Address
First Line : PO BOX 841969
Second Line :
City : DALLAS
State : TX
Zip : 75284-1969
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1919 S BRAESWOOD BLVD
Second Line : 5TH FLOOR
City : HOUSTON
State : TX
Zip : 77030-4412
Country : US
Telephone Number : 832-824-6633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 07/08/2007

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Directions to “ SUE JONG M.D.” Practice Location

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