Provider Demographics
NPI:1336456961
Name:PYON, CONNIE JUNG (PHAM D)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:JUNG
Last Name:PYON
Suffix:
Gender:F
Credentials:PHAM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ALAMO PLZ
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1550
Mailing Address - Country:US
Mailing Address - Phone:925-820-1233
Mailing Address - Fax:925-820-9472
Practice Address - Street 1:130 ALAMO PLZ
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507-1550
Practice Address - Country:US
Practice Address - Phone:925-820-1233
Practice Address - Fax:925-820-9472
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist