Provider Demographics
NPI:1093458523
Name:AUNG, JEREMY TIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:TIN
Last Name:AUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9290 TOWNE CENTRE DR UNIT 84
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3044
Mailing Address - Country:US
Mailing Address - Phone:818-903-0384
Mailing Address - Fax:
Practice Address - Street 1:3455 SENN RD BLDG 72
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-1098
Practice Address - Country:US
Practice Address - Phone:818-903-0384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
VA0101279438208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program