Provider Demographics
NPI:1487880852
Name:JOH, JENNIFER EUNJOO (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EUNJOO
Last Name:JOH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 SAINT PAUL PL FL 5
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2001
Mailing Address - Country:US
Mailing Address - Phone:410-332-9330
Mailing Address - Fax:410-347-1175
Practice Address - Street 1:227 SAINT PAUL PL FL 5
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2001
Practice Address - Country:US
Practice Address - Phone:410-332-9330
Practice Address - Fax:410-347-1175
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245550208600000X
FLME106363208600000X
MDD0073837208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery