MEDICARE: DR. YOUNG JUNG

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	183500000X	Pharmacist	81822	CA

General Provider Information

NPI Number	:	1710510672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOUNG JUNG

Provider Business Mailing Address
First Line	:	1319 N EL PRADO DR APT C
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-5635
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	927 S CHINA LAKE BLVD
Second Line	:
City	:	RIDGECREST
State	:	CA
Zip	:	93555-6315
Country	:	US
Telephone Number	:	760-384-4020
Fax Number	:

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

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	02/19/2020

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