MEDICARE: DR. SEONG-JOO JEONG 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
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	35.088657	OH
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	2007-00949	NC
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	46133	TN
4	207RP1001X	Pulmonary Disease Physician	46133	TN
5	207RP1001X	Pulmonary Disease Physician	35.088657	OH
6	207RP1001X	Pulmonary Disease Physician	0101248183	VA
7	207RP1001X	Pulmonary Disease Physician	2007-00949	NC
8	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	0101248183	VA

General Provider Information

NPI Number	:	1538240072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEONG-JOO JEONG M. D.

Provider Business Mailing Address
First Line	:	1009 EVANWOOD DR
Second Line	:
City	:	LOOKOUT MTN
State	:	TN
Zip	:	37350-1445
Country	:	US
Telephone Number	:	423-509-8917
Fax Number	:	423-697-6100

Provider Business Practice Location Address
First Line	:	1009 EVANWOOD DR
Second Line	:
City	:	LOOKOUT MTN
State	:	TN
Zip	:	37350-1445
Country	:	US
Telephone Number	:	423-509-8917
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	06/09/2025

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