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General NPI Number Information
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NPI Number | 1487177879
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Entity Type | Individual
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Provider Name | SUE JEONG
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Gender | Female
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 236 W MOUNTAIN ST STE 202E
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City | PASADENA
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State | CA
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Zip | 91103-2969
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Country | US
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Telephone | 626-808-5249
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Fax |
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Provider Business Mailing Address
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Address Line | 1062 N ALTADENA DR
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City | PASADENA
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State | CA
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Zip | 91107-1852
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Country | US
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Telephone | 626-808-5249
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 100282
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License Number State | CA
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