Provider Demographics
NPI:1376964122
Name:JEON, SOPHIA S (LAC)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:S
Last Name:JEON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:250 W 1ST ST STE 312
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4740
Mailing Address - Country:US
Mailing Address - Phone:909-625-8999
Mailing Address - Fax:
Practice Address - Street 1:15592 MARNIE PL
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4595
Practice Address - Country:US
Practice Address - Phone:213-703-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15107171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist