Healthcare Provider Details

I. General information

NPI: 1295632040
Provider Name (Legal Business Name): JUDY JUYOUNG JEONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2026
Last Update Date: 10/23/2026
Certification Date: 10/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W HUNTINGTON DR # A200
ARCADIA CA
91007-3050
US

IV. Provider business mailing address

125 W HUNTINGTON DR # A200
ARCADIA CA
91007-3050
US

V. Phone/Fax

Practice location:
  • Phone: 626-574-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95041221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: