Provider Demographics
NPI:1346408226
Name:SOUNG, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 E 17TH ST
Mailing Address - Street 2:SUITE W248
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2201
Mailing Address - Country:US
Mailing Address - Phone:714-547-5151
Mailing Address - Fax:714-547-4027
Practice Address - Street 1:1125 E 17TH STREET
Practice Address - Street 2:SUITE W248
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2205
Practice Address - Country:US
Practice Address - Phone:714-547-5151
Practice Address - Fax:714-547-4027
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105043207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology