Provider Demographics
NPI:1396516704
Name:JEON, YOUNG A
Entity type:Individual
Prefix:
First Name:YOUNG A
Middle Name:
Last Name:JEON
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 1:211 JUNIPER WAY
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-6285
Mailing Address - Country:US
Mailing Address - Phone:213-359-3069
Mailing Address - Fax:
Practice Address - Street 1:211 JUNIPER WAY
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-6285
Practice Address - Country:US
Practice Address - Phone:213-359-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA802083163W00000X
CA19311171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty