Individual
DR. JAE KEITH JOUNG
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
55 FRUIT ST, GRB 235 PATHOLOGY ASSOCIATES, BOSTON, MA 02114-2696
(617) 726-8887
(617) 726-5684
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
204131
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0102911
—
MA
01
—
204131
TUFTS HEALTH PLAN
MA
01
—
J22414
BCBS MA
MA
Enumeration date
12/02/2005
Last updated
07/08/2007
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