Provider Demographics
NPI:1528009503
Name:JUNG, VICTOR H (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:H
Last Name:JUNG
Suffix:
Gender:M
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:PO BOX 101018
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-1018
Mailing Address - Country:US
Mailing Address - Phone:512-583-0205
Mailing Address - Fax:512-583-2001
Practice Address - Street 1:618 5TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5612
Practice Address - Country:US
Practice Address - Phone:530-749-4400
Practice Address - Fax:530-749-4534
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHL1032582085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G404830Medicaid
CAG40483OtherMEDICAL LICENSE
CAG40483OtherMEDICAL LICENSE
CA00G404830Medicaid
CADR608ZMedicare PIN