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General NPI Number Information
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NPI Number | 1558446872
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Entity Type | Individual
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Provider Name | KIMBERLY MERLIN JUNG L.C.S.W
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 2001 S BARRINGTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90025-5363
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Country | US
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Telephone | 310-478-3711
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Fax |
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Provider Business Mailing Address
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Address Line | 4007 LEEWARD AVE
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City | LOS ANGELES
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State | CA
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Zip | 90005-3542
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Country | US
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Telephone | 917-312-6912
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 29724
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0721351
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License Number State | NY
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