Provider Demographics
NPI:1306898499
Name:JEONG, WOONDONG (MD)
Entity type:Individual
Prefix:DR
First Name:WOONDONG
Middle Name:
Last Name:JEONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22710 PROFESSIONAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6009
Mailing Address - Country:US
Mailing Address - Phone:281-358-2850
Mailing Address - Fax:281-719-5927
Practice Address - Street 1:506 GRAHAM DR STE 120
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-3346
Practice Address - Country:US
Practice Address - Phone:281-516-0236
Practice Address - Fax:281-719-5930
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9883207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX337755803Medicaid
TX337755801Medicaid
MEME2058Medicare ID - Type Unspecified
MEP00343225Medicare PIN
MEME205801Medicare PIN
TX337755801Medicaid
ME432297699Medicaid