Provider Demographics
NPI:1396559001
Name:JEUNG, AVA
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:JEUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16001 LEGACY RD UNIT 302
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-2776
Mailing Address - Country:US
Mailing Address - Phone:916-462-7983
Mailing Address - Fax:
Practice Address - Street 1:6153 COLGATE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3127
Practice Address - Country:US
Practice Address - Phone:323-433-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst