Provider Demographics
NPI:1164446068
Name:UNG, LYNN (R PH)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:
Last Name:UNG
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S SANTA ANITA AVE
Mailing Address - Street 2:SUITE G-10
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1146
Mailing Address - Country:US
Mailing Address - Phone:626-281-6800
Mailing Address - Fax:626-281-6696
Practice Address - Street 1:207 S SANTA ANITA AVE
Practice Address - Street 2:SUITE G-10
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1146
Practice Address - Country:US
Practice Address - Phone:626-281-6800
Practice Address - Fax:626-281-6696
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA467170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA467170Medicaid
CA5117070001Medicare ID - Type Unspecified