Jeong, Dae Hyoun

Jeong, Dae Hyoun is an individual health care provider with primary practice located at 520 N 4Th St , Springfield IL 62702-5238. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Geriatric Medicine, Allopathic & Osteopathic Physicians / Sports Medicine, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Clinical Exercise Physiologist, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Jeong, Dae Hyoun can be contacted via phone (217) 545-8000.

Contact Information

Primary practice address
520 N 4Th St Springfield IL 62702-5238
Phone: (217) 545-8000
Fax: (217) 747-1351
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Geriatric Medicine 207QG0300X 036-135215 Illinois
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 036-135215 Illinois
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Clinical Exercise Physiologist 224Y00000X 036-135215 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036135215 Illinois

Profile Details

NPI number 1265729818
LBN Legal business name Jeong, Dae Hyoun
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2011
Last updated Nov 17th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265729818 NPPES
Illinois MEDICAID 036135215

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