Healthcare Provider Details

I. General information

NPI: 1629213194
Provider Name (Legal Business Name): JAMIE YNGJYE HUNG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 GLASSON WAY SUITE L10
GRASS VALLEY CA
95945-5723
US

IV. Provider business mailing address

3400 DATA DR PHYSICIAN SUPPORT SERVICES - 2ND FL
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 530-274-6677
  • Fax: 530-274-6678
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number20A13322
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number20A13322
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number20A13322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: