Healthcare Provider Details

I. General information

NPI: 1467970996
Provider Name (Legal Business Name): JUICHUNG HUNG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38600 MEDICAL CENTER DR
PALMDALE CA
93551-4483
US

IV. Provider business mailing address

18425 LOS ALIMOS ST
NORTHRIDGE CA
91326-3124
US

V. Phone/Fax

Practice location:
  • Phone: 661-382-5000
  • Fax:
Mailing address:
  • Phone: 818-438-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JUICHUNG HUNG
Title or Position: SOLE OWNER
Credential: MD
Phone: 818-438-7098