Healthcare Provider Details

I. General information

NPI: 1023876711
Provider Name (Legal Business Name): HYUN JUNG JEON PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 MORAGA RD
MORAGA CA
94556-2211
US

IV. Provider business mailing address

640 MORAGA RD APT 107
MORAGA CA
94556-2294
US

V. Phone/Fax

Practice location:
  • Phone: 925-631-0204
  • Fax:
Mailing address:
  • Phone: 925-787-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: