Provider Demographics
NPI:1538045109
Name:JEONG, ALIZA AUTUMN
Entity type:Individual
Prefix:
First Name:ALIZA
Middle Name:AUTUMN
Last Name:JEONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3607
Mailing Address - Country:US
Mailing Address - Phone:714-686-3334
Mailing Address - Fax:
Practice Address - Street 1:1725 HARDING AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3607
Practice Address - Country:US
Practice Address - Phone:714-686-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program