Provider Demographics
NPI:1205079795
Name:JUNG, EDWARD (DC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10349 BALBOA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-7379
Mailing Address - Country:US
Mailing Address - Phone:818-363-3100
Mailing Address - Fax:818-363-5353
Practice Address - Street 1:10349 BALBOA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-7379
Practice Address - Country:US
Practice Address - Phone:818-363-3100
Practice Address - Fax:818-363-5353
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30563111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner