Individual
TAE HO JEONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4001 W MCNICHOLS RD, DETROIT, MI 48221-3038
(313) 578-0358
Mailing address
4001 W MCNICHOLS RD, DETROIT, MI 48221-3038
(313) 578-0358
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704408472
MI
Other
Enumeration date
04/16/2026
Last updated
04/22/2026
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