Hee Soo Jeong MD a Professional Medical Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A105825 Issued in CA

Legal business name

HEE SOO JEONG MD A PROFESSIONAL MEDICAL CORPORATION

Practice address

2675 W Olympic Blvd
Suite 202
Los Angeles, CA 90006-2880

Phone

(213) 387-1541

Fax

(866) 531-4907

NPI assigned

May 12, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hee Soo Jeong, M.D.NPI 1174701429

Title

President

Phone

(213) 387-1541

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mirae Medical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heesoo Jeong, M.D.

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1174701429
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399852800000",
    "number": "1407267586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 W OLYMPIC BLVD",
            "address_2": "SUITE 202",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062880",
            "telephone_number": "213-387-1541",
            "fax_number": "866-531-4907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2675 W OLYMPIC BLVD",
            "address_2": "SUITE 202",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062880",
            "telephone_number": "213-387-1541",
            "fax_number": "866-531-4907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEE SOO JEONG MD A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-12",
        "last_updated": "2014-05-12",
        "status": "A",
        "authorized_official_last_name": "JEONG",
        "authorized_official_first_name": "HEE SOO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-387-1541",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A105825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "A105825",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mirae Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole L Hedlund, AMFT
• Rebecca Marie Hedrick, MD
• Jasmine Hedvat
• Hee Jee Yoon DDS, Inc.
• Hee Jin Chang DDS, Inc
• Timothy Richard Heege-Graves
• Jaeden Heesch
• Isaac G Heesen, APRN-RX
• Jennifer Heetderks, PSYD
• Allison Hefley, PSY.D

• Internal Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.