Healthcare Provider Details

I. General information

NPI: 1932077260
Provider Name (Legal Business Name): ERIC Y JUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: YUNJUN JUNG

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17707 STUDEBAKER RD
CERRITOS CA
90703-2640
US

IV. Provider business mailing address

5882 BURNHAM AVE APT 6
BUENA PARK CA
90621-1839
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-0688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberASW130857
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW130857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: