Healthcare Provider Details

I. General information

NPI: 1669721700
Provider Name (Legal Business Name): MINA MISOON JUNG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MI SOON JUNG RN

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

V. Phone/Fax

Practice location:
  • Phone: 562-708-1808
  • Fax:
Mailing address:
  • Phone: 562-708-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number23192
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number627394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: