Healthcare Provider Details

I. General information

NPI: 1093644478
Provider Name (Legal Business Name): LAUREN AMITHIDA UNG RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2646 GLEN COTSWOLD CT
SAN JOSE CA
95148-2544
US

IV. Provider business mailing address

2646 GLEN COTSWOLD CT
SAN JOSE CA
95148-2544
US

V. Phone/Fax

Practice location:
  • Phone: 408-564-1363
  • Fax:
Mailing address:
  • Phone: 408-564-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number50182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: