Provider Demographics
NPI:1659152841
Name:MONICA JUNG DPM, INC
Entity Type:Organization
Organization Name:MONICA JUNG DPM, INC
Other - Org Name:JUPITER FOOT & ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:213-786-1088
Mailing Address - Street 1:266 S HARVARD BLVD STE 370
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3987
Mailing Address - Country:US
Mailing Address - Phone:213-254-7103
Mailing Address - Fax:
Practice Address - Street 1:266 S HARVARD BLVD STE 370
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3987
Practice Address - Country:US
Practice Address - Phone:213-786-1088
Practice Address - Fax:213-487-7505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric