Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 101866 | CA |
NPI | 1629610738 |
---|---|
Provider Name | Dr. Ha Ra Jeon |
First Address | Tustin, CA 92780-6960 |
Second Address | Tustin, CA 92780-6960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2019 |
Last Update Date | 09/10/2019 |