Provider Demographics
NPI:1720536147
Name:ALBUS, DA JUNG (SLP)
Entity Type:Individual
Prefix:
First Name:DA JUNG
Middle Name:
Last Name:ALBUS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DA JUNE
Other - Last Name:MCDOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3570 LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4023
Mailing Address - Country:US
Mailing Address - Phone:989-506-6598
Mailing Address - Fax:
Practice Address - Street 1:3570 LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-4023
Practice Address - Country:US
Practice Address - Phone:989-506-6598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 23587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist