MEDICARE: DR. DAVID 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	207K00000X	Allergy & Immunology Physician	D0070669	MD
2	207K00000X	Allergy & Immunology Physician	MD600003736	DC
3	207K00000X	Allergy & Immunology Physician	338468-01	NY
4	207K00000X	Allergy & Immunology Physician	0101278820	VA
5	207K00000X	Allergy & Immunology Physician	MD60021238	WA
6	207K00000X	Allergy & Immunology Physician	25MA12831100	NJ

General Provider Information

NPI Number	:	1912023565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JEONG M.D.

Provider Business Mailing Address
First Line	:	622 W 168TH ST PH 17
Second Line	:	ROOM 114
City	:	NEW YORK
State	:	NY
Zip	:	10032-3720
Country	:	US
Telephone Number	:	212-305-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 WESTCHESTER AVE
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10604-3525
Country	:	US
Telephone Number	:	914-229-5000
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	01/09/2026

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