Provider Demographics
NPI:1881652352
Name:JEON, HOONBAE (MD)
Entity type:Individual
Prefix:
First Name:HOONBAE
Middle Name:
Last Name:JEON
Suffix:
Gender:
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:504-988-2317
Mailing Address - Fax:504-988-1838
Practice Address - Street 1:4320 HOUMA BLVD STE 700
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2673
Practice Address - Country:US
Practice Address - Phone:504-988-5344
Practice Address - Fax:504-988-5262
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2025-02-26
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