Provider Demographics
NPI:1689725566
Name:JUN, ANGELA H (NP)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:H
Last Name:JUN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:HAE JEONG
Other - Middle Name:
Other - Last Name:JO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:141 HOLLOW TREE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0839
Mailing Address - Country:US
Mailing Address - Phone:714-319-9634
Mailing Address - Fax:
Practice Address - Street 1:11911 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90701-4065
Practice Address - Country:US
Practice Address - Phone:562-402-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR.N. 482413363LF0000X
CA15836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3210479OtherDRIVERS LICENSE
CA2005009533OtherBOARD CERTIFICATION