Healthcare Provider Details

I. General information

NPI: 1124969944
Provider Name (Legal Business Name): ANNA JUNG LICENSED MARRIAGE FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAUREL ST STE B
SAN CARLOS CA
94070-3964
US

IV. Provider business mailing address

1001 LAUREL ST STE B
SAN CARLOS CA
94070-3964
US

V. Phone/Fax

Practice location:
  • Phone: 650-416-6436
  • Fax:
Mailing address:
  • Phone: 650-416-6436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANNA JUNG
Title or Position: ANNA JUNG CEO
Credential: LMFT
Phone: 415-271-8995