Provider Demographics
NPI:1437413952
Name:WOO, JEAN JUNG (NP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:JUNG
Last Name:WOO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:J
Other - Last Name:WOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:19111 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-8989
Mailing Address - Country:US
Mailing Address - Phone:760-242-7777
Mailing Address - Fax:
Practice Address - Street 1:1890 W MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3726
Practice Address - Country:US
Practice Address - Phone:760-256-1422
Practice Address - Fax:760-255-1006
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily