Grace H Jeon M D M P H F a C S a Professional Corporation

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

G84081 Issued in CA

Legal business name

GRACE H JEON M D M P H F A C S A PROFESSIONAL CORPORATION

Practice address

1211 W la Palma Ave Ste 705
Anaheim, CA 92801-2814

Phone

(714) 772-6701

Fax

(714) 772-5240

NPI assigned

May 25, 2007

Organization subpart

No

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

Authorized official

Name

Grace Jeon, MD

Title

President

Phone

(818) 720-7113

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1417168758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 W LA PALMA AVE STE 705",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012814",
            "telephone_number": "714-772-6701",
            "fax_number": "714-772-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 W LA PALMA AVE STE 705",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012814",
            "telephone_number": "714-772-6701",
            "fax_number": "714-772-5240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE H JEON M D M P H F A C S A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "JEON",
        "authorized_official_first_name": "GRACE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-720-7113",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "G84081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G840810",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Grace Family Medical Center, Inc.
• Grace Family Medical Group
• Grace Young, M.D., Inc.
• Cole Thomas Grace
• Graceful Care Home Health Services Inc.
• Graceful Day Personal Home Care
• Gracious Hospice LLC

• Surgery Physician in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.