Healthcare Provider Details

I. General information

NPI: 1417870957
Provider Name (Legal Business Name): JOANNE JEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNE LEE

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-7521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: