Provider Demographics
NPI:1033607932
Name:JEON, YONG NAM (DNP, CRNP, AGNP-C)
Entity type:Individual
Prefix:DR
First Name:YONG NAM
Middle Name:
Last Name:JEON
Suffix:
Gender:M
Credentials:DNP, CRNP, AGNP-C
Other - Prefix:DR
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:JEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, CRNP, AGNP-C
Mailing Address - Street 1:50 W EDMONSTON DR STE 202
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1249
Mailing Address - Country:US
Mailing Address - Phone:301-762-0788
Mailing Address - Fax:
Practice Address - Street 1:50 W EDMONSTON DR STE 202
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1249
Practice Address - Country:US
Practice Address - Phone:301-762-0788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207262363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health