Healthcare Provider Details

I. General information

NPI: 1861002578
Provider Name (Legal Business Name): JUNG HOON HUR RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 PRESTWICK LN
PALMDALE CA
93551-5380
US

IV. Provider business mailing address

3941 PRESTWICK LN
PALMDALE CA
93551-5380
US

V. Phone/Fax

Practice location:
  • Phone: 661-470-0587
  • Fax:
Mailing address:
  • Phone: 661-470-0587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number41026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: