Basic Information
| Provider Information | |||||||||
| NPI: | 1184791204 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEON | ||||||||
| FirstName: | NAM | ||||||||
| MiddleName: | WOOK | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L. AC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3550 AIRPORT WAY STE 4 | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997094772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077503534 | ||||||||
| FaxNumber: | 9074790164 | ||||||||
| Practice Location | |||||||||
| Address1: | 3550 AIRPORT WAY STE 4 | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997094772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077503534 | ||||||||
| FaxNumber: | 9074790164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 10/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 90 | AK | Y | Other Service Providers | Acupuncturist |
No ID Information.