Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A96231 | CA |
NPI | 1346435476 |
---|---|
Provider Name | Inga Pak Jeon |
First Address | Cypress, CA 90630-5453 |
Second Address | Whittier, CA 90606-2758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2007 |
Last Update Date | 10/11/2021 |