Healthcare Provider Details

I. General information

NPI: 1487223384
Provider Name (Legal Business Name): TIFFANY JEEHAE SON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 07/17/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 BARRANCA PKWY STE 260
IRVINE CA
92604-4780
US

IV. Provider business mailing address

4040 BARRANCA PKWY STE 260
IRVINE CA
92604-4780
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA203038
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2023013096
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: