Provider Demographics
NPI:1851083414
Name:HATAE, ADRIENNE JEONG
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:JEONG
Last Name:HATAE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 FIESTA PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3407
Mailing Address - Country:US
Mailing Address - Phone:626-235-5611
Mailing Address - Fax:
Practice Address - Street 1:401 FIESTA PL
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3407
Practice Address - Country:US
Practice Address - Phone:626-235-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597721835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care