Provider Demographics
NPI:1437398989
Name:PAE, MI JUNG (PHD)
Entity Type:Individual
Prefix:DR
First Name:MI JUNG
Middle Name:
Last Name:PAE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MI
Other - Middle Name:JUNG
Other - Last Name:PAE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:701 SCOFIELD AVE
Mailing Address - Street 2:P.O. BOX 8800
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-7515
Mailing Address - Country:US
Mailing Address - Phone:661-758-8400
Mailing Address - Fax:
Practice Address - Street 1:701 SCOFIELD AVE
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-7515
Practice Address - Country:US
Practice Address - Phone:661-758-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19327103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical