Provider Demographics
NPI:1861375214
Name:JEONG, HEE JAE
Entity type:Individual
Prefix:
First Name:HEE JAE
Middle Name:
Last Name:JEONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8271 RIPPLE RDG
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-6434
Mailing Address - Country:US
Mailing Address - Phone:847-915-9802
Mailing Address - Fax:
Practice Address - Street 1:665 PASQUINELLI DR # B-203
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1279
Practice Address - Country:US
Practice Address - Phone:331-251-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001627171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist