Provider Demographics
NPI:1013946375
Name:JUNG, JAE YEON (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:YEON
Last Name:JUNG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950132
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0132
Mailing Address - Country:US
Mailing Address - Phone:888-980-8992
Mailing Address - Fax:
Practice Address - Street 1:3810 SPRINGHURST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:502-583-1749
Practice Address - Fax:502-329-8184
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49240207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology