Healthcare Provider Details

I. General information

NPI: 1609303221
Provider Name (Legal Business Name): JISUN SUNNY FISHER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2017
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30262 CROWN VALLEY PKWY STE B-303
LAGUNA NIGUEL CA
92677-2364
US

IV. Provider business mailing address

30262 CROWN VALLEY PKWY STE B-303
LAGUNA NIGUEL CA
92677-2364
US

V. Phone/Fax

Practice location:
  • Phone: 973-531-6079
  • Fax:
Mailing address:
  • Phone: 973-531-6079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00574700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: