Healthcare Provider Details

I. General information

NPI: 1295149508
Provider Name (Legal Business Name): DR. YONG H JUNG, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 S RAINBOW BLVD SUITE 101
LAS VEGAS NV
89118-2534
US

IV. Provider business mailing address

5755 S RAINBOW BLVD SUITE 101
LAS VEGAS NV
89118-2534
US

V. Phone/Fax

Practice location:
  • Phone: 702-331-1333
  • Fax: 702-331-0808
Mailing address:
  • Phone: 702-331-1333
  • Fax: 702-331-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01053
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberB01053
License Number StateNV

VIII. Authorized Official

Name: DR. KIET MICHAEL LAM
Title or Position: ASSOCIATE DOCTOR
Credential: D.C.
Phone: 702-354-5581