Provider Demographics
NPI:1740585983
Name:KWON, JESSICA J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:J
Last Name:KWON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:J
Other - Last Name:KWON-NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 6270
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-6270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 PLACENTIA AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3306
Practice Address - Country:US
Practice Address - Phone:949-574-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist