Provider Demographics
NPI:1881652352
Name:JEON, HOONBAE (MD)
Entity Type:Individual
Prefix:
First Name:HOONBAE
Middle Name:
Last Name:JEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HOON BAE
Other - Middle Name:
Other - Last Name:JEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1430 TULANE AVE # 8622
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2632
Mailing Address - Country:US
Mailing Address - Phone:504-988-5128
Mailing Address - Fax:504-988-1838
Practice Address - Street 1:1415 TULANE AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-988-5110
Practice Address - Fax:504-988-0644
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA304568204F00000X
IL336.083973208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2437488Medicaid
LA565156YJB9OtherMEDICARE
H41963Medicare UPIN