Provider Demographics
NPI:1013895671
Name:JEONG, PETER SEOKSU
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:SEOKSU
Last Name:JEONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12438 RUNNINGCREEK LN
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2048
Mailing Address - Country:US
Mailing Address - Phone:818-572-7888
Mailing Address - Fax:
Practice Address - Street 1:12438 RUNNINGCREEK LN
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2048
Practice Address - Country:US
Practice Address - Phone:818-572-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20427171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist