Provider Demographics
NPI:1659864015
Name:YUN, JEONG WOOK (OMD)
Entity Type:Individual
Prefix:
First Name:JEONG
Middle Name:WOOK
Last Name:YUN
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13020 TRIADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1124
Mailing Address - Country:US
Mailing Address - Phone:443-765-2007
Mailing Address - Fax:
Practice Address - Street 1:3448 ELLICOTT CENTER DR STE 103
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4668
Practice Address - Country:US
Practice Address - Phone:443-765-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02477171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist