Healthcare Provider Details

I. General information

NPI: 1831728351
Provider Name (Legal Business Name): LISA MINJEE JUNG ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 E COLORADO BLVD # 1078
PASADENA CA
91107-3870
US

IV. Provider business mailing address

3660 E COLORADO BLVD # 1078
PASADENA CA
91107-3870
US

V. Phone/Fax

Practice location:
  • Phone: 626-607-1787
  • Fax:
Mailing address:
  • Phone: 626-607-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: