Healthcare Provider Details

I. General information

NPI: 1366928855
Provider Name (Legal Business Name): ANGELA JEUNG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA PINACHOS DO

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 S 1470 E STE 200
ST GEORGE UT
84790-1764
US

IV. Provider business mailing address

1115 S SUNSET AVE
WEST COVINA CA
91790-3940
US

V. Phone/Fax

Practice location:
  • Phone: 435-688-0759
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9268396
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12749195-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: