| NPI | 1033982749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYOUNG JEONG Provider 469-216-1102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-11-03 |
| Last Update Date | 2026-04-30 |