Healthcare Provider Details

I. General information

NPI: 1093330474
Provider Name (Legal Business Name): HUN HEE JEONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N JACK TONE RD
RIPON CA
95366-9513
US

IV. Provider business mailing address

4416 PRECISSI LN APT 40
STOCKTON CA
95207-6234
US

V. Phone/Fax

Practice location:
  • Phone: 209-599-1639
  • Fax:
Mailing address:
  • Phone: 408-497-6493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: