Individual provider Active NPI

Daniel Y Jeong

  • Student in an Organized Health Care Education/Training Program
  • Johns Creek, GA
National Provider Identifier
1003765256
Registry record updated Jan 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
640 Kimball Parc Way
Johns Creek, GA 30022-2631
Phone
(678) 978-1664
NPI assigned
Jan 22, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

640 Kimball Parc Way
Johns Creek, GA 30022-2631

Mailing address

640 Kimball Parc Way
Johns Creek, GA 30022-2631

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1769040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769040000000",
    "number": "1003765256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 KIMBALL PARC WAY",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300222631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 KIMBALL PARC WAY",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300222631",
            "telephone_number": "678-978-1664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEONG",
        "first_name": "DANIEL",
        "middle_name": "Y",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-01-22",
        "last_updated": "2026-01-22",
        "certification_date": "2026-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johns Creek, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.