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General NPI Number Information
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NPI Number | 1093082885
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Entity Type | Individual
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Provider Name | JIMAN JUNG NP
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Gender | Male
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 01/05/2022
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Provider Practice Location Address
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Address Line | 20627 GOLDEN SPRINGS DR STE 2D&E
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City | DIAMOND BAR
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State | CA
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Zip | 91789-4814
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Country | US
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Telephone | 909-480-0099
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Fax | 909-480-0088
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Provider Business Mailing Address
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Address Line | 20627 GOLDEN SPRINGS DR STE 2D&E
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City | DIAMOND BAR
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State | CA
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Zip | 91789-4814
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Country | US
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Telephone | 94-800-0999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP60243614
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95002124
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License Number State | CA
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