Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 1024 | NV |
N | 111NI0900X | Internist | 1024 | NV |
Y | 207RG0300X | Geriatric Medicine | 1024 | NV |
NPI | 1144251075 |
---|---|
Provider Name | Dr. Mike Y Jeong |
First Address | Las Vegas, NV 89117-1501 |
Second Address | Las Vegas, NV 89117-1501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 20/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002018471 | (05) | NV |
H13332 | (02) | NV |