Provider Demographics
NPI:1962040675
Name:JUNG, JENNY HYUNJI (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:HYUNJI
Last Name:JUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9898 RAVARI DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3553
Mailing Address - Country:US
Mailing Address - Phone:714-403-5420
Mailing Address - Fax:
Practice Address - Street 1:27750 SANTA MARGARITA PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6653
Practice Address - Country:US
Practice Address - Phone:949-770-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA79394OtherCALIFORNIA BOARD OF PHARMACY