Healthcare Provider Details

I. General information

NPI: 1912623661
Provider Name (Legal Business Name): JOY JEHEE KWON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7212 ORANGETHORPE AVE STE 8
BUENA PARK CA
90621-4667
US

IV. Provider business mailing address

8081 STANTON AVE
BUENA PARK CA
90620-3237
US

V. Phone/Fax

Practice location:
  • Phone: 949-572-0137
  • Fax:
Mailing address:
  • Phone: 714-503-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: