Provider Demographics
NPI:1346554227
Name:JU, JEONG-EUN
Entity Type:Individual
Prefix:
First Name:JEONG-EUN
Middle Name:
Last Name:JU
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 1:2007 VILLAGE RUN RD
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8899
Mailing Address - Country:US
Mailing Address - Phone:724-799-8393
Mailing Address - Fax:
Practice Address - Street 1:2007 VILLAGE RUN RD
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8899
Practice Address - Country:US
Practice Address - Phone:724-799-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000916171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist