MEDICARE: JUNG MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154356921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNG MEDICAL CENTER

Provider Business Mailing Address
First Line	:	3511 W OLYMPIC BLVD
Second Line	:	#101
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3563
Country	:	US
Telephone Number	:	323-766-1057
Fax Number	:	323-766-8790

Provider Business Practice Location Address
First Line	:	3511 W OLYMPIC BLVD
Second Line	:	#101
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3563
Country	:	US
Telephone Number	:	323-766-1057
Fax Number	:	323-766-8790

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES JUNG
Credential	:	MD
Telephone Number	:	323-766-1057

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/22/2020

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Directions to “JUNG MEDICAL CENTER ” Practice Location

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