MEDICARE: C. G. JUNG INSTITUTE OF LOS ANGELES

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	251S00000X	Community/Behavioral Health Agency		CA

General Provider Information

NPI Number	:	1912116534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C. G. JUNG INSTITUTE OF LOS ANGELES

Provider Business Mailing Address
First Line	:	10349 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2608
Country	:	US
Telephone Number	:	310-556-1193
Fax Number	:	310-556-2290

Provider Business Practice Location Address
First Line	:	10349 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2608
Country	:	US
Telephone Number	:	310-556-1193
Fax Number	:	310-556-2290

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. STEVEN J. FRANK
Credential	:	PH.D.
Telephone Number	:	310-556-1193

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/23/2007

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