Healthcare Provider Details

I. General information

NPI: 1942810098
Provider Name (Legal Business Name): MEAGHAN JUNG RN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

5275 CLAREMONT AVE
OAKLAND CA
94618-1032
US

V. Phone/Fax

Practice location:
  • Phone: 415-971-0048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95018535
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95202205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: