Provider Demographics
NPI:1154727931
Name:JEON, HYEJIN (DDS)
Entity type:Individual
Prefix:
First Name:HYEJIN
Middle Name:
Last Name:JEON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 S LA FAYETTE PARK PL APT 307
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1336
Mailing Address - Country:US
Mailing Address - Phone:269-845-5088
Mailing Address - Fax:
Practice Address - Street 1:257 S MARKET ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2305
Practice Address - Country:US
Practice Address - Phone:310-677-4767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA640561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice