Moonsun Jeong, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP95017339 Issued in CA

Practice address

3255 Wilshire Blvd Ste 120
Los Angeles, CA 90010-1405

Phone

(213) 235-2500

Fax

(213) 355-8714

NPI assigned

May 5, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Korean Health Education Information and Research Center

  • Primary Care Clinic/Center
  • Los Angeles, CA
  • NPI 1437377454
  Medicare reassignment NPD
• St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1073653630
  Medicare reassignment NPD
• Korean Health, Education, Information and Research Center

  • Community/Retail Pharmacy
  • Los Angeles, CA
  • NPI 1093562589
  NPD
• Prime Urgent Care Inc

  • Urgent Care Clinic/Center
  • Encino, CA
  • NPI 1659138444
  NPD
• St. Johns Community Health

  • Community Health Clinic/Center
  • Compton, CA
  • NPI 1043542111
  NPD
• St. Johns Community Health

  • Community Health Clinic/Center
  • Los Angeles, CA
  • NPI 1073363768
  NPD
• Korean Health Education Information and Research Center

  • Primary Care Clinic/Center
  • Los Angeles, CA
  • NPI 1902568330
  NPD (past)
• St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • San Bernardino, CA
  • NPI 1780376947
  NPD (past)

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

{
    "created_epoch": "1620172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631750400000",
    "number": "1740863828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3727 W 6TH ST STE 210",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900205108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 WILSHIRE BLVD STE 120",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900101405",
            "telephone_number": "213-235-2500",
            "fax_number": "213-355-8714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEONG",
        "first_name": "MOONSUN",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-05",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95017339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaeeun Jeong
• Janie Jeong
• Jennifer K Jeong, AGACNP
• Jessica Namyoung Jeong, OTD, OTR/L
• Jiyeon Monica Jeong
• Myeong Jeong
• Paul Jeong, DDS
• Peter Jeong
• Sumin Jeong
• Sun Young Jeong, MD, MPH

• Family Nurse Practitioner in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.