Provider Demographics
NPI:1952051468
Name:JUNG, AE YOUNG
Entity Type:Individual
Prefix:
First Name:AE YOUNG
Middle Name:
Last Name:JUNG
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 1:5550 WILSHIRE BLVD APT 330
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4859
Mailing Address - Country:US
Mailing Address - Phone:949-838-4288
Mailing Address - Fax:
Practice Address - Street 1:5550 WILSHIRE BLVD APT 330
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4859
Practice Address - Country:US
Practice Address - Phone:949-838-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17707171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty