Provider Demographics
NPI:1184979072
Name:TUNG, JAN (OD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:TUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W VALLEY BLVD
Mailing Address - Street 2:#115
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3760
Mailing Address - Country:US
Mailing Address - Phone:626-288-8023
Mailing Address - Fax:626-288-8326
Practice Address - Street 1:140 W VALLEY BLVD
Practice Address - Street 2:#115
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3760
Practice Address - Country:US
Practice Address - Phone:626-288-8023
Practice Address - Fax:626-288-8326
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist