Provider Demographics
NPI:1114466877
Name:CHUN, JEDIDIAH CHI TSUN (LMFT)
Entity Type:Individual
Prefix:
First Name:JEDIDIAH
Middle Name:CHI TSUN
Last Name:CHUN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E MISSION RD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2847
Mailing Address - Country:US
Mailing Address - Phone:626-281-9280
Mailing Address - Fax:
Practice Address - Street 1:715 E MISSION RD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-2847
Practice Address - Country:US
Practice Address - Phone:626-281-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF96282101YM0800X, 106H00000X
CALMFT127960106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health