Provider Demographics
NPI:1063677474
Name:MYUNG, PEGGY SUEJIN (MD, PHD)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:SUEJIN
Last Name:MYUNG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:360 STATE ST
Mailing Address - Street 2:APT 3103
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3601
Mailing Address - Country:US
Mailing Address - Phone:215-668-7559
Mailing Address - Fax:
Practice Address - Street 1:15 YORK ST
Practice Address - Street 2:LMP 5031
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3221
Practice Address - Country:US
Practice Address - Phone:215-668-7559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT52769207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207N00000XAllopathic & Osteopathic PhysiciansDermatology