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General NPI Number Information
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NPI Number | 1861386443
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Entity Type | Individual
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Provider Name | BRIEANNA LEE JUNG PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 700 W IRONWOOD DR STE 341
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4404
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Country | US
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Telephone | 208-625-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 9702 N HAUSER LAKE RD
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City | HAUSER
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State | ID
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Zip | 83854-5528
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Country | US
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Telephone | 208-704-2604
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 8671366
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License Number State | ID
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