Provider Demographics
NPI:1750721395
Name:JEONG, SHARON GRACE (LAC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:GRACE
Last Name:JEONG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 30TH ST
Mailing Address - Street 2:UNIT 509
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3076
Mailing Address - Country:US
Mailing Address - Phone:510-432-2460
Mailing Address - Fax:
Practice Address - Street 1:9320 CARMEL MOUNTAIN RD
Practice Address - Street 2:SUITE F
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2159
Practice Address - Country:US
Practice Address - Phone:858-705-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15263171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist