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NPI Code Detail

MEDICARE: MR. KENTON JUNG L.C.S.W.

MEDICARE: MR. KENTON JUNG L.C.S.W.
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
11041C0700XClinical Social WorkerLCS4469CA

General Provider Information

NPI Number : 1194940759
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENTON JUNG L.C.S.W.
Provider Business Mailing Address
First Line : 1863 KASHLAN RD
Second Line :
City : LA HABRA HEIGHTS
State : CA
Zip : 90631-8455
Country : US
Telephone Number : 562-690-2923
Fax Number : 562-690-5666
Provider Business Practice Location Address
First Line : 1863 KASHLAN RD
Second Line :
City : LA HABRA HEIGHTS
State : CA
Zip : 90631-8455
Country : US
Telephone Number : 562-690-2923
Fax Number : 562-690-5666
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 07/08/2007

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