Provider Demographics
NPI:1982361119
Name:JEONG, SEHYUN (RPH)
Entity Type:Individual
Prefix:DR
First Name:SEHYUN
Middle Name:
Last Name:JEONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:DR
Other - First Name:HARRY
Other - Middle Name:
Other - Last Name:JEONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2105 MORRILL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-1130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2105 MORRILL AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-1130
Practice Address - Country:US
Practice Address - Phone:408-263-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist