Provider Demographics
NPI:1598204307
Name:JEON, DANIEL MYUNG HOON (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MYUNG HOON
Last Name:JEON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2784 FOXBOROUGH PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-1408
Mailing Address - Country:US
Mailing Address - Phone:714-397-1203
Mailing Address - Fax:
Practice Address - Street 1:15141 WHITTIER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2156
Practice Address - Country:US
Practice Address - Phone:562-945-1587
Practice Address - Fax:562-696-9687
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist