=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568945459
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHER JEONG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2018
-----------------------------------------------------
Last Update Date | 05/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 E COMPTON BLVD
-----------------------------------------------------
City | COMPTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90220-2413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-604-1747
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3215 W PICO BLVD APT 404
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90019-3657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 86225
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------