Provider Demographics
NPI:1902040561
Name:UN, JANE JUNE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:JUNE
Last Name:UN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S WESTRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3733
Mailing Address - Country:US
Mailing Address - Phone:714-606-8862
Mailing Address - Fax:
Practice Address - Street 1:1666 N. MAIN ST SUITE 400
Practice Address - Street 2:WESTERN YOUTH SERVICES/BOYS AND GIRLS CLUB
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4599
Practice Address - Country:US
Practice Address - Phone:714-532-7951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health