=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528336765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNY HUNG OD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2011
-----------------------------------------------------
Last Update Date | 12/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1827 WALNUT GROVE AVE
-----------------------------------------------------
City | ROSEMEAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91770-3789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-312-2712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2827 GINGER CT
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835-4326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-425-4005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. JENNY P HUNG
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 626-312-2712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 13252 TLG
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------