MEDICARE: YOUNGRAN JEONG M.S.

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	235Z00000X	Speech-Language Pathologist	016059	NY

General Provider Information

NPI Number	:	1760612428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUNGRAN JEONG M.S.

Provider Business Mailing Address
First Line	:	12333 83RD AVE APT 1107
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-3436
Country	:	US
Telephone Number	:	917-754-0655
Fax Number	:

Provider Business Practice Location Address
First Line	:	12333 83RD AVE APT 1107
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-3436
Country	:	US
Telephone Number	:	917-754-0655
Fax Number	:

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

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	07/15/2009

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Directions to “ YOUNGRAN JEONG M.S.” Practice Location

Language	Start Address	Practice Location

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