Healthcare Provider Details

I. General information

NPI: 1740414606
Provider Name (Legal Business Name): SARA JEAN RUNGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 E 7TH ST # 419
LONG BEACH CA
90804-5003
US

IV. Provider business mailing address

3350 E 7TH ST # 419
LONG BEACH CA
90804-5003
US

V. Phone/Fax

Practice location:
  • Phone: 213-281-9405
  • Fax:
Mailing address:
  • Phone: 213-281-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number107577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: