Healthcare Provider Details

I. General information

NPI: 1265519441
Provider Name (Legal Business Name): JANE YEOUN CHUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E TULARE AVE
VISALIA CA
93292-3629
US

IV. Provider business mailing address

4843 COMMONWEALTH AVE
LA CANADA CA
91011-2506
US

V. Phone/Fax

Practice location:
  • Phone: 559-788-1200
  • Fax:
Mailing address:
  • Phone: 818-952-2614
  • Fax: 805-388-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG63039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: