Provider Demographics
NPI:1508346065
Name:JEON, HYEONGJIN (HYEONGJIN)
Entity Type:Individual
Prefix:
First Name:HYEONGJIN
Middle Name:
Last Name:JEON
Suffix:
Gender:M
Credentials:HYEONGJIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14943 35TH AVE
Mailing Address - Street 2:APT 6K
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15408 NORTHERN BLVD STE 2F
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5042
Practice Address - Country:US
Practice Address - Phone:718-939-1275
Practice Address - Fax:718-939-1277
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist