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General NPI Number Information
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NPI Number | 1407267586
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Entity Type | Organization
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Legal Business Name | HEE SOO JEONG MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 2675 W OLYMPIC BLVD SUITE 202
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City | LOS ANGELES
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State | CA
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Zip | 90006-2880
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Country | US
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Telephone | 213-387-1541
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Fax | 866-531-4907
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Provider Business Mailing Address
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Address Line | 2675 W OLYMPIC BLVD SUITE 202
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City | LOS ANGELES
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State | CA
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Zip | 90006-2880
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Country | US
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Telephone | 213-387-1541
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Fax | 866-531-4907
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Authorized Official
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Title or Position | PRESIDENT
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Name | HEE SOO JEONG
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Credential | M.D.
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Telephone | 213-387-1541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A105825
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License Number State | CA
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