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NPI Code Detail

MEDICARE: CALEB JEON

MEDICARE: CALEB JEON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207N00000XDermatology Physician163750CA

General Provider Information

NPI Number : 1528558160
Entity Type Code : Individual
Provider Name (Legal Business Name) : CALEB JEON
Provider Business Mailing Address
First Line : 2333 KAPIOLANI BLVD APT 3011
Second Line :
City : HONOLULU
State : HI
Zip : 96826-4468
Country : US
Telephone Number : 808-386-1659
Fax Number :
Provider Business Practice Location Address
First Line : 2255 YGNACIO VALLEY RD STE B1
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94598-3335
Country : US
Telephone Number : 925-945-7005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2018
Last Update Date : 10/04/2022

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Directions to “ CALEB JEON ” Practice Location

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