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General NPI Number Information
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NPI Number | 1790827673
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Entity Type | Organization
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Legal Business Name | MAN YOUNG JUNG
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 2264 LINCOLN AVE
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City | ALTADENA
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State | CA
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Zip | 91001-5432
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Country | US
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Telephone | 626-794-7197
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Fax | 626-794-3371
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Provider Business Mailing Address
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Address Line | 2264 LINCOLN AVE
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City | ALTADENA
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State | CA
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Zip | 91001-5432
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUN JUNG
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Credential | RPH
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Telephone | 626-794-7197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY33830
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License Number State | CA
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