Provider Demographics
NPI:1841792546
Name:JEON, NA EUN (OTR/L)
Entity Type:Individual
Prefix:
First Name:NA EUN
Middle Name:
Last Name:JEON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:
Other - Last Name:JEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4519 MEYER PARK CIR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-6749
Mailing Address - Country:US
Mailing Address - Phone:510-789-9430
Mailing Address - Fax:
Practice Address - Street 1:2400 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5332
Practice Address - Country:US
Practice Address - Phone:310-856-0800
Practice Address - Fax:510-793-7222
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
106S00000X
CA22170225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician