Provider Demographics
NPI:1275982464
Name:JEUNG, GEORGE (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:JEUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 E RIVERSIDE DR STE A
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6897
Mailing Address - Country:US
Mailing Address - Phone:435-673-1149
Mailing Address - Fax:
Practice Address - Street 1:368 E RIVERSIDE DR STE A
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6897
Practice Address - Country:US
Practice Address - Phone:435-673-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL1163207R00000X
NVDO2552207R00000X
UT12742773-1204207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine