Healthcare Provider Details

I. General information

NPI: 1154883973
Provider Name (Legal Business Name): HEE-JIN JUNG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 WILSHIRE BLVD STE 600
LOS ANGELES CA
90017-3907
US

IV. Provider business mailing address

126 KENSINGTON AVE
NORWOOD NJ
07648-1925
US

V. Phone/Fax

Practice location:
  • Phone: 213-278-0021
  • Fax: 213-278-0973
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number20A24241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: