Provider Demographics
NPI:1871149948
Name:JEON, ANTHONE T (NP-C)
Entity type:Individual
Prefix:
First Name:ANTHONE
Middle Name:T
Last Name:JEON
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:91-1107 KAILIPOLIPO ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6506
Mailing Address - Country:US
Mailing Address - Phone:916-704-3566
Mailing Address - Fax:808-943-8732
Practice Address - Street 1:1357 KAPIOLANI BLVD STE 1460
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4509
Practice Address - Country:US
Practice Address - Phone:808-942-1852
Practice Address - Fax:808-943-8732
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2749363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care