Healthcare Provider Details

I. General information

NPI: 1386176774
Provider Name (Legal Business Name): HYEEUN JUNG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 LINCOLN ST
OROVILLE CA
95966-5961
US

IV. Provider business mailing address

1975 BRUCE RD APT 110
CHICO CA
95928-7255
US

V. Phone/Fax

Practice location:
  • Phone: 530-534-7500
  • Fax:
Mailing address:
  • Phone: 626-590-0947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: