Provider Demographics
NPI:1821788746
Name:HYUN, JEONG HO
Entity Type:Individual
Prefix:
First Name:JEONG
Middle Name:HO
Last Name:HYUN
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 1:1107 GOLDEN SPRINGS DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4257
Mailing Address - Country:US
Mailing Address - Phone:310-404-3277
Mailing Address - Fax:
Practice Address - Street 1:1107 GOLDEN SPRINGS DR UNIT D
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4257
Practice Address - Country:US
Practice Address - Phone:310-404-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program