Provider Demographics
NPI:1376695197
Name:JUNG, JENNIFER D (PT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:D
Last Name:JUNG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 470607
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94147-0607
Mailing Address - Country:US
Mailing Address - Phone:415-561-6655
Mailing Address - Fax:415-561-6650
Practice Address - Street 1:1162B GORGAS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94129-1406
Practice Address - Country:US
Practice Address - Phone:415-561-6655
Practice Address - Fax:415-561-6650
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT260710Medicare PIN