Healthcare Provider Details

I. General information

NPI: 1578490462
Provider Name (Legal Business Name): HI JAE JUNG M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK AVE
NEW YORK NY
10016-5802
US

IV. Provider business mailing address

3900 CHESTNUT ST APT 904
PHILADELPHIA PA
19104-3125
US

V. Phone/Fax

Practice location:
  • Phone: 646-754-5000
  • Fax: 646-754-9538
Mailing address:
  • Phone: 484-767-5479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: