MEDICARE: NICHOLAS JUNG M.D.

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	207L00000X	Anesthesiology Physician	A107536	CA

General Provider Information

NPI Number	:	1861625170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS JUNG M.D.

Provider Business Mailing Address
First Line	:	2 STONEPATH
Second Line	:
City	:	NEWPORT COAST
State	:	CA
Zip	:	92657-1641
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S MANCHESTER AVE STE 130
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-3216
Country	:	US
Telephone Number	:	714-456-3526
Fax Number	:

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

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	05/10/2024

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