MEDICARE: KIONGLEE JUNG FNP/PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP5635	AZ
2	363LF0000X	Family Nurse Practitioner	AP5635	AZ

General Provider Information

NPI Number	:	1184039968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIONGLEE JUNG FNP/PMHNP

Provider Business Mailing Address
First Line	:	2430 W RAY RD STE 3
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-3552
Country	:	US
Telephone Number	:	480-613-9599
Fax Number	:	480-900-8515

Provider Business Practice Location Address
First Line	:	2430 W RAY RD STE 3
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-3552
Country	:	US
Telephone Number	:	480-613-9599
Fax Number	:	480-900-8515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	05/05/2026

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