Provider Demographics
NPI:1346203668
Name:JUN, PHILLIP NAM-KYU (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:NAM-KYU
Last Name:JUN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 N MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-3640
Mailing Address - Country:US
Mailing Address - Phone:714-480-6767
Mailing Address - Fax:714-568-4362
Practice Address - Street 1:1200 N MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3640
Practice Address - Country:US
Practice Address - Phone:714-480-6767
Practice Address - Fax:714-568-4362
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2007-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA340452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34045OtherCALIFORNIA STATE LICENSE
CAA34045OtherCALIFORNIA STATE LICENSE