Healthcare Provider Details

I. General information

NPI: 1043748627
Provider Name (Legal Business Name): DR. YOUNG YOON JEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 TUCKER RD
TEHACHAPI CA
93561-2510
US

IV. Provider business mailing address

15841 SNOWY PEAK LN
FONTANA CA
92336-4579
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-9232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number34655
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number78989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: