Healthcare Provider Details

I. General information

NPI: 1528558160
Provider Name (Legal Business Name): CALEB JEON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12462 PUTNAM ST STE 501
WHITTIER CA
90602-1049
US

IV. Provider business mailing address

12462 PUTNAM ST STE 501
WHITTIER CA
90602-1049
US

V. Phone/Fax

Practice location:
  • Phone: 562-789-5429
  • Fax:
Mailing address:
  • Phone: 562-789-5429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number163750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: