Provider Demographics
NPI:1215385240
Name:JUNG, EUN HAE
Entity Type:Individual
Prefix:
First Name:EUN HAE
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6771 BEACH BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3470
Mailing Address - Country:US
Mailing Address - Phone:714-752-6027
Mailing Address - Fax:714-676-5508
Practice Address - Street 1:6771 BEACH BLVD STE E
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3470
Practice Address - Country:US
Practice Address - Phone:714-752-6027
Practice Address - Fax:714-676-5508
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist