Provider Demographics
NPI:1568186005
Name:JEON, SANG DON
Entity Type:Individual
Prefix:
First Name:SANG DON
Middle Name:
Last Name:JEON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 W REDONDO BEACH BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3642
Mailing Address - Country:US
Mailing Address - Phone:714-340-6590
Mailing Address - Fax:
Practice Address - Street 1:24881 ALICIA PKWY STE N
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4617
Practice Address - Country:US
Practice Address - Phone:949-707-7100
Practice Address - Fax:424-340-2467
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19416171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty