MEDICARE: JIMAN JUNG NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP60243614	WA
2	363LF0000X	Family Nurse Practitioner	NP95002124	CA

General Provider Information

NPI Number	:	1093082885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMAN JUNG NP

Provider Business Mailing Address
First Line	:	20627 GOLDEN SPRINGS DR STE 2D&E
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91789-4814
Country	:	US
Telephone Number	:	94-800-0999
Fax Number	:

Provider Business Practice Location Address
First Line	:	20627 GOLDEN SPRINGS DR STE 2D&E
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91789-4814
Country	:	US
Telephone Number	:	909-480-0099
Fax Number	:	909-480-0088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2011
Last Update Date	:	01/05/2022

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