Provider Demographics
NPI:1164615266
Name:JUNG, JAEEUN (LAC)
Entity Type:Individual
Prefix:MISS
First Name:JAEEUN
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 DEEP VALLEY DR STE 207
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3654
Mailing Address - Country:US
Mailing Address - Phone:310-541-7999
Mailing Address - Fax:310-544-1969
Practice Address - Street 1:827 DEEP VALLEY DR STE 207
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3654
Practice Address - Country:US
Practice Address - Phone:310-541-7999
Practice Address - Fax:310-544-1969
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11638171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist