Provider Demographics
NPI:1578734448
Name:MYUNG KIL JEON, M.D.
Entity Type:Organization
Organization Name:MYUNG KIL JEON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:JEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-793-5073
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-0948
Mailing Address - Country:US
Mailing Address - Phone:252-793-5073
Mailing Address - Fax:252-793-3278
Practice Address - Street 1:1022 US HWY 64 E
Practice Address - Street 2:BLDG # 4
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-9215
Practice Address - Country:US
Practice Address - Phone:252-793-5073
Practice Address - Fax:252-793-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC45916OtherBLUE CROSS BLUE SHIELD
NC890286PMedicaid
NC8945916Medicaid
NC890286PMedicaid