Healthcare Provider Details

I. General information

NPI: 1578030540
Provider Name (Legal Business Name): YOOJIN HONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 HAMNER AVE
EASTVALE CA
91752-1009
US

IV. Provider business mailing address

13221 MURANO AVE
CHINO CA
91710-8117
US

V. Phone/Fax

Practice location:
  • Phone: 951-749-7190
  • Fax:
Mailing address:
  • Phone: 951-666-1916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79590
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number79590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: