Healthcare Provider Details

I. General information

NPI: 1396559001
Provider Name (Legal Business Name): AVA JEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6153 COLGATE AVE
LOS ANGELES CA
90036-3127
US

IV. Provider business mailing address

16001 LEGACY RD UNIT 302
TUSTIN CA
92782-2776
US

V. Phone/Fax

Practice location:
  • Phone: 323-433-4165
  • Fax:
Mailing address:
  • Phone: 916-462-7983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: