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NPI Code Detail

MEDICARE: JESSICA CHUNG MAC LCSW

MEDICARE: JESSICA CHUNG MAC LCSW
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
11041C0700XClinical Social Worker119283CA

General Provider Information

NPI Number : 1326561382
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA CHUNG MAC LCSW
Provider Business Mailing Address
First Line : 4365 IRONWOOD AVE
Second Line :
City : SEAL BEACH
State : CA
Zip : 90740-2923
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 253 S DIAMOND BAR BLVD
Second Line :
City : DIAMOND BAR
State : CA
Zip : 91765-1606
Country : US
Telephone Number : 909-860-1144
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2017
Last Update Date : 04/23/2025

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