Healthcare Provider Details

I. General information

NPI: 1548877285
Provider Name (Legal Business Name): YANGHOON PETER JEONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2020
Last Update Date: 03/30/2026
Certification Date: 12/24/2020
Deactivation Date: 03/27/2025
Reactivation Date: 03/30/2026

III. Provider practice location address

1795 E LUGONIA AVE
REDLANDS CA
92374-2723
US

IV. Provider business mailing address

25278 TAYLOR ST APT A
LOMA LINDA CA
92354-3026
US

V. Phone/Fax

Practice location:
  • Phone: 190-979-4172
  • Fax:
Mailing address:
  • Phone: 951-966-8528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: