Provider Demographics
NPI:1720339351
Name:JEON, KI HYUN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KI
Middle Name:HYUN
Last Name:JEON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COTTONWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3412
Mailing Address - Country:US
Mailing Address - Phone:213-675-3109
Mailing Address - Fax:213-365-2855
Practice Address - Street 1:2858 W 8TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1235
Practice Address - Country:US
Practice Address - Phone:213-365-2858
Practice Address - Fax:213-365-3855
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-22
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9920171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC9920OtherSTATE LICENSE NUMBER