Provider Demographics
NPI:1174883144
Name:JEON, JONG HEE (L AC)
Entity type:Individual
Prefix:
First Name:JONG
Middle Name:HEE
Last Name:JEON
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 E VALLEY BLVD
Mailing Address - Street 2:#25
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-3160
Mailing Address - Country:US
Mailing Address - Phone:714-350-4781
Mailing Address - Fax:
Practice Address - Street 1:2865 E VALLEY BLVD
Practice Address - Street 2:#25
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-3160
Practice Address - Country:US
Practice Address - Phone:714-350-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11548171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist