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General NPI Number Information
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NPI Number | 1437028578
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Entity Type | Individual
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Provider Name | CHANMIN JEON
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Gender | Male
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 505 S VIRGIL AVE STE 206
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City | LOS ANGELES
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State | CA
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Zip | 90020-1443
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Country | US
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Telephone | 213-622-0021
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Fax |
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Provider Business Mailing Address
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Address Line | 2321 W 10TH ST UNIT 201
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City | LOS ANGELES
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State | CA
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Zip | 90006-2246
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Country | US
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Telephone |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95037498
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License Number State | CA
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