Basic Information
| Provider Information | |||||||||
| NPI: | 1881045219 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYONG | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | SUNGJOO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1031 HIGHLANDS PLAZA DR W | ||||||||
| Address2: | 508 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487035244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3635 VISTA AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631102539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142687133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2016 | ||||||||
| LastUpdateDate: | 10/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2018034810 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 036.148759 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | D90633 | MD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.