Active NPI
Ji Won Jeon
- Pharmacist
- Flushing, NY
National Provider Identifier
1417416850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 065229
- Practice address
- 15007 Northern Blvd
Flushing, NY 11354-4968 - Phone
- (718) 358-3800
- NPI assigned
- Mar 15, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 065229 | NY | Primary |
Addresses
Primary practice location
15007 Northern Blvd
Flushing, NY 11354-4968
Mailing address
1 Royal Oak Dr
Huntington, NY 11743-4427
Phone (917) 943-7712
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 065229 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smile Pharmacy, Inc | Past | Accepting new patients | |
| JW Spark II LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Flushing, NY
- NPI 1770053134
-
- Community/Retail Pharmacy
- Flushing, NY
- NPI 1588723407
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552608000000",
"number": "1417416850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 ROYAL OAK DR",
"city": "HUNTINGTON",
"state": "NY",
"postal_code": "117434427",
"telephone_number": "917-943-7712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15007 NORTHERN BLVD",
"city": "FLUSHING",
"state": "NY",
"postal_code": "113544968",
"telephone_number": "718-358-3800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEON",
"first_name": "JI WON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-15",
"last_updated": "2019-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "065229",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flushing, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.