Provider Demographics
NPI:1043684517
Name:JEONG, SEONGHUN (PT)
Entity Type:Individual
Prefix:
First Name:SEONGHUN
Middle Name:
Last Name:JEONG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21502 46TH AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3437
Mailing Address - Country:US
Mailing Address - Phone:213-309-8179
Mailing Address - Fax:
Practice Address - Street 1:1283 W DUNDEE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4009
Practice Address - Country:US
Practice Address - Phone:847-632-9919
Practice Address - Fax:773-585-6201
Is Sole Proprietor?:No
Enumeration Date:2015-11-21
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045412225100000X
IL070021866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist