Healthcare Provider Details

I. General information

NPI: 1265537765
Provider Name (Legal Business Name): MARY S JUNG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 E CHAPMAN AVE
ORANGE CA
92866-2231
US

IV. Provider business mailing address

1506 E CHAPMAN AVE
ORANGE CA
92866-2231
US

V. Phone/Fax

Practice location:
  • Phone: 714-538-8556
  • Fax: 714-538-1082
Mailing address:
  • Phone: 714-538-8556
  • Fax: 714-538-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA73312
License Number StateCA

VIII. Authorized Official

Name: MARY SUN JUNG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-538-8556