Provider Demographics
NPI:1265867832
Name:JEON, SUJIN
Entity Type:Individual
Prefix:MISS
First Name:SUJIN
Middle Name:
Last Name:JEON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SUZIE
Other - Middle Name:
Other - Last Name:JEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1007 S PLYMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-6806
Mailing Address - Country:US
Mailing Address - Phone:602-448-0578
Mailing Address - Fax:
Practice Address - Street 1:115 1/2 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3896
Practice Address - Country:US
Practice Address - Phone:602-448-0578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CALCSW855601041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical