Provider Demographics
NPI:1598728859
Name:JUNG, JENNIFER YU-SHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:YU-SHAN
Last Name:JUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6013
Mailing Address - Country:US
Mailing Address - Phone:415-431-3100
Mailing Address - Fax:
Practice Address - Street 1:34 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6013
Practice Address - Country:US
Practice Address - Phone:415-431-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12186T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0121862Medicare ID - Type Unspecified
SD0121860Medicare ID - Type Unspecified
U91927Medicare UPIN
SD0121861Medicare ID - Type Unspecified