Individual
KI SOO JUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
105505
GA
2084N0400X
Neurology Physician
Primary
200400364
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89136T1
—
NC
01
—
P00387970
RAILROAD MEDICARE
NC
01
—
Q00247071
RAILROAD MEDICARE
NC
Enumeration date
09/20/2005
Last updated
05/01/2026
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