Healthcare Provider Details

I. General information

NPI: 1386530939
Provider Name (Legal Business Name): SEAN TY UNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W KIMBERLY AVE STE 220
PLACENTIA CA
92870-6314
US

IV. Provider business mailing address

701 W KIMBERLY AVE STE 220
PLACENTIA CA
92870-6314
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-4274
  • Fax: 999-999-9999
Mailing address:
  • Phone: 714-879-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: