Provider Demographics
NPI:1063835494
Name:JEON, SEUNGYE
Entity Type:Individual
Prefix:MS
First Name:SEUNGYE
Middle Name:
Last Name:JEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14447 38TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5954
Mailing Address - Country:US
Mailing Address - Phone:347-933-2448
Mailing Address - Fax:
Practice Address - Street 1:211 PERRY PKWY
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2144
Practice Address - Country:US
Practice Address - Phone:301-916-8540
Practice Address - Fax:301-916-8476
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006017171100000X
NY035505225100000X
MD26084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist