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General NPI Number Information
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NPI Number | 1265951016
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Entity Type | Individual
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Provider Name | JESSICA JUN NP
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Gender | Female
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 415 W ROUTE 66 STE 202
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City | GLENDORA
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State | CA
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Zip | 91740-4335
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Country | US
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Telephone | 626-963-4467
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Fax |
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Provider Business Mailing Address
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Address Line | 415 W ROUTE 66 STE 202
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City | GLENDORA
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State | CA
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Zip | 91740-4335
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Country | US
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Telephone | 626-963-4467
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95015676
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95096295
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License Number State | CA
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