Healthcare Provider Details

I. General information

NPI: 1992153381
Provider Name (Legal Business Name): ERIC JUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 1070W
LOS ANGELES CA
90048-6137
US

IV. Provider business mailing address

5350 WILSHIRE BLVD #361111
LOS ANGELES CA
90036-8272
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-4746
  • Fax: 310-423-1886
Mailing address:
  • Phone: 512-387-6304
  • Fax: 323-370-0452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLP03706
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberLP03706
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA166412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: