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General NPI Number Information
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NPI Number | 1902954134
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Entity Type | Individual
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Provider Name | PETER BYUNGCHUL JUNG O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 7101 LA TIJERA BLVD # J-102
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City | LOS ANGELES
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State | CA
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Zip | 90045-2174
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Country | US
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Telephone | 626-833-5455
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Fax | 310-645-1443
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Provider Business Mailing Address
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Address Line | 18600 S FIGUEROA ST
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City | GARDENA
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State | CA
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Zip | 90248-4505
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Country | US
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Telephone | 626-833-5455
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Fax | 310-645-1443
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11665T
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License Number State | CA
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