Healthcare Provider Details

I. General information

NPI: 1467855338
Provider Name (Legal Business Name): IRENE TUNG-PHAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IRENE TUNG PHD

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 S COAST HWY STE 196
LAGUNA BEACH CA
92651-3681
US

IV. Provider business mailing address

1968 S COAST HWY STE 196
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 949-357-0481
  • Fax:
Mailing address:
  • Phone: 949-357-0481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY33938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: