Provider Demographics
NPI:1184791204
Name:JEON, NAM WOOK (L AC)
Entity type:Individual
Prefix:MR
First Name:NAM
Middle Name:WOOK
Last Name:JEON
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
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Mailing Address - Street 1:3550 AIRPORT WAY STE 4
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-4772
Mailing Address - Country:US
Mailing Address - Phone:907-750-3534
Mailing Address - Fax:907-479-0164
Practice Address - Street 1:3550 AIRPORT WAY STE 4
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4772
Practice Address - Country:US
Practice Address - Phone:907-750-3534
Practice Address - Fax:907-479-0164
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK90171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist