Active NPI
Kellie Jeong
- Internal Medicine Physician
- Tucson, AZ
National Provider Identifier
1063253292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- R4283
- Practice address
- 7901 E 22ND St
Tucson, AZ 85710-8509 - Phone
- (520) 694-8888
- Fax
- (520) 694-8466
- NPI assigned
- Jun 3, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | R4283 | AZ | Primary |
Addresses
Primary practice location
7901 E 22ND St
Tucson, AZ 85710-8509
Mailing address
7901 E 22ND St
Tucson, AZ 85710-8509
Phone (520) 694-8888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240716002013 | AZ | Order and Referring Only - Internal Medicine | 1456896356 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1717372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717372800000",
"number": "1063253292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7901 E 22ND ST",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857108509",
"telephone_number": "520-694-8888",
"fax_number": "520-694-8466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7901 E 22ND ST",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857108509",
"telephone_number": "520-694-8888",
"fax_number": "520-694-8466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEONG",
"first_name": "KELLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-03",
"last_updated": "2024-06-03",
"certification_date": "2024-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "AZ",
"license": "R4283",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.