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General NPI Number Information
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NPI Number | 1265537765
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Entity Type | Organization
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Legal Business Name | MARY S JUNG MD INC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 1506 E CHAPMAN AVE
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City | ORANGE
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State | CA
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Zip | 92866-2231
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Country | US
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Telephone | 714-538-8556
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Fax | 714-538-1082
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Provider Business Mailing Address
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Address Line | 1506 E CHAPMAN AVE
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City | ORANGE
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State | CA
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Zip | 92866-2231
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Country | US
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Telephone | 714-538-8556
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Fax | 714-538-1082
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY SUN JUNG
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Credential | M.D.
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Telephone | 714-538-8556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A73312
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License Number State | CA
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