Provider Demographics
NPI:1518456474
Name:JUNG, MI KYEONG (RN)
Entity Type:Individual
Prefix:
First Name:MI KYEONG
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 S 45TH ST UNIT 7
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2950
Mailing Address - Country:US
Mailing Address - Phone:253-754-1575
Mailing Address - Fax:
Practice Address - Street 1:RAF LAKENHEATH HOSPITAL
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SUFFOLK
Practice Address - Zip Code:IP27 9PN
Practice Address - Country:GB
Practice Address - Phone:314-226-8762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR233058163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse