Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 19425 | NV |
NPI | 1043656051 |
---|---|
Provider Name | Dr. William Jun Jeong |
First Address | Las Vegas, NV 89113-2236 |
Second Address | Las Vegas, NV 89113-2236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2013 |
Last Update Date | 27/07/2020 |