Provider Demographics
NPI:1659390847
Name:PERNG, JIUNN CHYONG (MD)
Entity Type:Individual
Prefix:
First Name:JIUNN
Middle Name:CHYONG
Last Name:PERNG
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 1:3125 SAVIERS RD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-5310
Mailing Address - Country:US
Mailing Address - Phone:805-483-0131
Mailing Address - Fax:805-483-0132
Practice Address - Street 1:3125 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-5310
Practice Address - Country:US
Practice Address - Phone:805-483-0131
Practice Address - Fax:805-483-0132
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32126207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A321260Medicaid
CAA032126Medicare ID - Type Unspecified
CA00A321260Medicaid