Provider Demographics
NPI:1376237446
Name:JEONG, YE KYUNG (NP)
Entity Type:Individual
Prefix:
First Name:YE KYUNG
Middle Name:
Last Name:JEONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 VALLECITO DR
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-3343
Mailing Address - Country:US
Mailing Address - Phone:626-224-6064
Mailing Address - Fax:
Practice Address - Street 1:19745 COLIMA RD STE 12
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-3219
Practice Address - Country:US
Practice Address - Phone:909-595-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily