DR. ABRAHAM WUSEOK JEON (NPI# 1104232636) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104232636 |
| Entity Type | Individual |
| Full Name | DR. ABRAHAM WUSEOK JEON |
| Credential | DO |
| Practice Address |
4800 College St Se Pmg Sw Wa Lacey Fam Med Lacey WA 98503 |
| Mailing Address |
Po Box 3360 Portland OR 97208-3360 |
| Practice Telephone | 3604862900 |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2017-10-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | OP60777650 | WA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063650190 | Abraham Hyeon Jeon | Radiology | 2722 Merrilee Dr, Suite 230, Fairfax, VA 22031-4420 | 2009-01-27 |
| Street Address |
4800 COLLEGE ST SE PMG SW WA LACEY FAM MED |
| City | LACEY |
| State | WA |
| Zip Code | 98503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457339319 | Sandra Loyer | Physician Assistant | 4800 College St Se, Lacey, WA 98503-4389 | 2006-01-02 |
| 1114568540 | Karen Lee Newman | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2019-10-07 |
| 1124674965 | Michaela Jane De Groot | Physical Therapist | 4800 College St Se, Lacey, WA 98503-4389 | 2019-08-16 |
| 1912475666 | Andrew Thomas | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2018-11-09 |
| 1487151577 | Tana Russell | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2018-04-06 |
| 1215431697 | Providence Health & Services Washington | Clinic/Center | 4800 College St Se, Lacey, WA 98503-4389 | 2018-03-21 |
| 1194229732 | Joanne Marie Mulder | Physician Assistant | 4800 College St Se, Lacey, WA 98503 | 2018-03-20 |
| 1467986802 | Danilynn Benavente | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2017-04-12 |
| 1245761675 | Sophia Stanley | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2017-03-27 |
| 1992236814 | Virginia Harris | Counselor | 4800 College St Se, Lacey, WA 98503-4389 | 2017-03-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457838989 | Michele Nordgren Bourque | Psychologist | 4329 Concordia Lane Se, Lacey, WA 98503 | 2018-07-26 |
| 1831638675 | Trevor John Marum | Chiropractor | 3945 8th Ave Se, Lacey, WA 98503 | 2017-02-13 |
| 1366993362 | Vanessa Julie Iglesias Mehta | Physician Assistant | 5128 Yelm Hwy Se, Suite E, Lacey, WA 98503 | 2016-10-14 |
| 1144683616 | Millenda Thomas | Registered Nurse | 1233 Firpark Dr. S.e., Lacey, WA 98503 | 2016-04-01 |
| 1609257245 | Erika Charlotte Vonkotzebue | Counselor | 4401 37th Ave. Se #25, Lacey, WA 98503 | 2015-06-09 |
| 1437576196 | Candy Nelson | Registered Nurse | 4410 6th Ave Se, Apt# 115, Lacy, WA 98503 | 2014-03-19 |
| 1134563919 | Alvin Fitzgerald | Pharmacist | 665 Sleater Kinney Rd., S.e, Target Pharmacy #1355, Lacey, WA 98503 | 2013-04-23 |
| 1518200724 | Katherine Mary Marsh | Psychologist | 5191 Corporate Center Court Se, Lacey, WA 98503 | 2013-04-05 |
| 1740530906 | Leanna Marie Mcbroom | Massage Therapist | 1608 Diamond Loop Se, Lacey, WA 98503 | 2012-09-14 |
| 1831445196 | Joyce Emily Christensen Coniff | Counselor | 5706 39th Ave Se., Lacey, WA 98503 | 2012-07-24 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710219522 | Warren Physician Services | Family Medicine | 5420 22nd Ave Se, Lacey, WA 98503-2804 | 2010-02-03 |
| 1538331418 | Eric Daniel Thomas | Family Medicine | 130 Marvinrd Se #112, Express Urgent Care, Lacey, WA 98503 | 2008-03-31 |
| 1033309604 | Providence Health & Services Washington | Family Medicine | 1450 Northwest Lane Se, Lacey, WA 98503-6908 | 2007-07-30 |
| 1205951076 | Christian William Dahl | Family Medicine | 1009 College St., Lacey, WA 98503-5310 | 2007-03-20 |
| 1386788537 | Northwest Family Care Clinic Pllc | Family Medicine | 5203 Lacey Blvd Se, Suite A, Lacey, WA 98503-7236 | 2007-02-19 |
| 1558435958 | Myrna Palasi | Family Medicine | 4220 Ingleside Dr Se, Lacey, WA 98503-2108 | 2006-11-17 |
| 1033202767 | Ann Tosomeen | Family Medicine | 3928 Pacific Avenue, Lacey, WA 98503 | 2006-10-02 |
| 1417040460 | Llien Mong Tran | Family Medicine | 1202 Sleater Kinney Rd Se, Lacey, WA 98503-2316 | 2006-10-02 |
| 1982714317 | Lucinda Alpert Grande | Family Medicine | 5130 Corporate Center Ct Se, Pioneer Family Practice, Lacey, WA 98503-5957 | 2006-08-30 |
| 1235105719 | Ronald Charles Krauss | Family Medicine | 5602 Ruddell Rd Se, Lacey, WA 98503 | 2006-02-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.