Provider Demographics
NPI:1629610738
Name:JEON, HA RA (DDS)
Entity Type:Individual
Prefix:DR
First Name:HA RA
Middle Name:
Last Name:JEON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2492 WALNUT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6960
Mailing Address - Country:US
Mailing Address - Phone:949-679-6000
Mailing Address - Fax:949-679-6001
Practice Address - Street 1:2492 WALNUT AVE STE 200
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6960
Practice Address - Country:US
Practice Address - Phone:949-679-6000
Practice Address - Fax:949-679-6001
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1018661223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health