Provider Demographics
NPI:1093082885
Name:JUNG, JIMAN (NP)
Entity Type:Individual
Prefix:
First Name:JIMAN
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20627 GOLDEN SPRINGS DR STE 2D&E
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4814
Mailing Address - Country:US
Mailing Address - Phone:094-800-0999
Mailing Address - Fax:
Practice Address - Street 1:20627 GOLDEN SPRINGS DR STE 2D&E
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91789-4814
Practice Address - Country:US
Practice Address - Phone:909-480-0099
Practice Address - Fax:909-480-0088
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60243614363LF0000X
CANP95002124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily