Healthcare Provider Details

I. General information

NPI: 1215592076
Provider Name (Legal Business Name): SEAN HP JUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HANSANG PARK

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

FILE 57326
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA176727
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA176727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: