Provider Demographics
NPI:1205348687
Name:HUNG, JIM (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:
Last Name:HUNG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 MARINA DR APT K
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-2979
Mailing Address - Country:US
Mailing Address - Phone:626-329-9299
Mailing Address - Fax:
Practice Address - Street 1:1700 MISSION ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4745
Practice Address - Country:US
Practice Address - Phone:831-457-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist