Provider Demographics
NPI:1104075308
Name:JUNG, JIYEON (MD)
Entity type:Individual
Prefix:DR
First Name:JIYEON
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14212-1845
Mailing Address - Country:US
Mailing Address - Phone:716-893-8550
Mailing Address - Fax:716-893-4020
Practice Address - Street 1:1500 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-1845
Practice Address - Country:US
Practice Address - Phone:716-893-8550
Practice Address - Fax:716-893-4020
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine