Provider Demographics
NPI:1326401035
Name:JEONG, HANEOL SAM (MD)
Entity type:Individual
Prefix:DR
First Name:HANEOL
Middle Name:SAM
Last Name:JEONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12700 PARK CENTRAL DR STE 1210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1522
Mailing Address - Country:US
Mailing Address - Phone:214-987-3376
Mailing Address - Fax:469-532-0273
Practice Address - Street 1:5655 W SPRING CREEK PKWY STE 105
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4176
Practice Address - Country:US
Practice Address - Phone:214-919-3500
Practice Address - Fax:214-919-3501
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2024-06-26
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Provider Licenses
StateLicense IDTaxonomies
TXS9718207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology