Provider Demographics
NPI:1831597061
Name:KWON, JIYUN JEAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JIYUN
Middle Name:JEAN
Last Name:KWON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 MEAD DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1390
Mailing Address - Country:US
Mailing Address - Phone:909-802-5073
Mailing Address - Fax:
Practice Address - Street 1:1670 EAST 120TH STREET
Practice Address - Street 2:MLK OC PHARMACY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059
Practice Address - Country:US
Practice Address - Phone:424-338-1972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH582591835P0018X
CAPH58259261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology