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General NPI Number Information
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NPI Number | 1265867832
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Entity Type | Individual
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Provider Name | MISS SUJIN JEON
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Gender | Female
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 115 1/2 N LARCHMONT BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90004-3896
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Country | US
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Telephone | 602-448-0578
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Fax |
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Provider Business Mailing Address
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Address Line | 1007 S PLYMOUTH BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-6806
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Country | US
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Telephone | 602-448-0578
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW85560
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License Number State | CA
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