Healthcare Provider Details

I. General information

NPI: 1316654064
Provider Name (Legal Business Name): JONATHAN LUN HOM ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 S BROOKHURST ST
ANAHEIM CA
92804-3510
US

IV. Provider business mailing address

18767 SAN FELIPE ST
FOUNTAIN VALLEY CA
92708-7435
US

V. Phone/Fax

Practice location:
  • Phone: 714-620-8131
  • Fax:
Mailing address:
  • Phone: 657-203-7807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number139367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: