Provider Demographics
NPI:1336652916
Name:JEON, DIANA SOYOUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:SOYOUNG
Last Name:JEON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26800 CROWN VALLEY PKWY STE 185
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-7304
Mailing Address - Country:US
Mailing Address - Phone:949-364-9009
Mailing Address - Fax:
Practice Address - Street 1:26800 CROWN VALLEY PKWY STE 185
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-7304
Practice Address - Country:US
Practice Address - Phone:949-364-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH77584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist