Healthcare Provider Details

I. General information

NPI: 1598138471
Provider Name (Legal Business Name): MR. DANIEL JEUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W MAIN ST SUITE 202
ALHAMBRA CA
91801-1694
US

IV. Provider business mailing address

2550 W MAIN ST SUITE 202
ALHAMBRA CA
91801-1694
US

V. Phone/Fax

Practice location:
  • Phone: 626-457-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 76808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: