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General NPI Number Information
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NPI Number | 1699858464
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Entity Type | Individual
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Provider Name | TODD MICHAEL JUNGKUNTZ PSYD
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 4929 WILSHIRE BLVD SUITE 510
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City | LOS ANGELES
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State | CA
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Zip | 90010-3808
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Country | US
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Telephone | 562-904-3999
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Fax | 855-688-6746
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Provider Business Mailing Address
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Address Line | 451 S MAIN ST #1108
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City | LOS ANGELES
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State | CA
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Zip | 90013-1338
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Country | US
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Telephone | 310-987-8526
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY26199
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License Number State | CA
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