Provider Demographics
NPI:1184039968
Name:JUNG, KIONGLEE (FNP/PMHNP)
Entity Type:Individual
Prefix:
First Name:KIONGLEE
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:FNP/PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 W RAY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3556
Mailing Address - Country:US
Mailing Address - Phone:480-613-9599
Mailing Address - Fax:480-900-8515
Practice Address - Street 1:2460 W RAY RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3556
Practice Address - Country:US
Practice Address - Phone:480-613-9599
Practice Address - Fax:480-900-8515
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5635363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily