Provider Demographics
NPI:1144493032
Name:JEON, MIN KYUNG (LIC AC)
Entity type:Individual
Prefix:
First Name:MIN KYUNG
Middle Name:
Last Name:JEON
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4792
Mailing Address - Country:US
Mailing Address - Phone:781-221-0162
Mailing Address - Fax:
Practice Address - Street 1:1 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4792
Practice Address - Country:US
Practice Address - Phone:781-221-0162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216023171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist