Provider Demographics
NPI:1083303994
Name:JEONG, HANA VIVIAN
Entity Type:Individual
Prefix:
First Name:HANA
Middle Name:VIVIAN
Last Name:JEONG
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 1:14932 APPALACHIAN TRL
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1906
Mailing Address - Country:US
Mailing Address - Phone:314-255-7423
Mailing Address - Fax:
Practice Address - Street 1:200 S OSTEOPATHY AVE
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1400
Practice Address - Country:US
Practice Address - Phone:314-255-7423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program