Provider Demographics
NPI:1013243237
Name:JUNG, THERESA (L AC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11547 SPRINGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-5116
Mailing Address - Country:US
Mailing Address - Phone:951-897-8540
Mailing Address - Fax:
Practice Address - Street 1:3593 ARLINGTON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3935
Practice Address - Country:US
Practice Address - Phone:951-897-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13370171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist