Provider Demographics
NPI:1578648358
Name:JUNG, PETER SU (DC)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:SU
Last Name:JUNG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N BROOKHURST ST
Mailing Address - Street 2:# 102
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5227
Mailing Address - Country:US
Mailing Address - Phone:714-817-7444
Mailing Address - Fax:888-234-2363
Practice Address - Street 1:520 N BROOKHURST ST
Practice Address - Street 2:# 102
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5227
Practice Address - Country:US
Practice Address - Phone:714-817-7444
Practice Address - Fax:888-234-2363
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11560202OtherQH
CA11560202OtherQH