Provider Demographics
NPI:1750342473
Name:JEON, MYUNG KIL (MD)
Entity type:Individual
Prefix:DR
First Name:MYUNG KIL
Middle Name:
Last Name:JEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 US HIGHWAY 64 E
Mailing Address - Street 2:PO BOX 707
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-9215
Mailing Address - Country:US
Mailing Address - Phone:252-793-5073
Mailing Address - Fax:252-793-3278
Practice Address - Street 1:1006 US HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-9215
Practice Address - Country:US
Practice Address - Phone:252-793-5073
Practice Address - Fax:252-793-3278
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20482208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8945916Medicaid
NC8945916Medicaid
NCC85326Medicare UPIN