Sang Joong Jeon, MEDICAL DOCTOR

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

010123580 Issued in VA

Practice address

10730 Main Street
Fairfax, VA 22030

Phone

(301) 317-0020

Fax

(301) 317-0028

NPI assigned

Sep 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354060800000",
    "number": "1033210869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207250639",
            "telephone_number": "301-317-0020",
            "fax_number": "301-317-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10730 MAIN STREET",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22030",
            "telephone_number": "301-317-0020",
            "fax_number": "301-317-0028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEON",
        "first_name": "SANG",
        "middle_name": "JOONG",
        "credential": "MEDICAL DOCTOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2012-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "010123580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS INDIVIDUAL",
            "identifier": "0007",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS GROUP",
            "identifier": "9105",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "112467",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010051207",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Nicole Jennings, RN, IBCLC
• Sabrina Kate Jennings, PH.D
• Abraham Hyeon Jeon, M.D.
• Chaeok Jeon, PHARM.D.
• Chaeyeun Jeon, L.AC
• Sooji Jeon
• Daseuli Jeong
• Hye Sun Jeong, LPC
• Peter Taejoo Jeong, DC
• Alisa Anne Jepson, PT, DPT

• Anesthesiology Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Anesthesiology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; 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.