Healthcare Provider Details

I. General information

NPI: 1467645622
Provider Name (Legal Business Name): EUNHEE JIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 S ATLANTIC BLVD
MONTEREY PARK CA
91754-6839
US

IV. Provider business mailing address

19420 PILARIO ST
ROWLAND HEIGHTS CA
91748-3143
US

V. Phone/Fax

Practice location:
  • Phone: 323-726-0385
  • Fax: 323-726-0597
Mailing address:
  • Phone: 626-964-5314
  • Fax: 626-964-5314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: