Provider Demographics
NPI:1649972670
Name:JUNG, HANA H
Entity type:Individual
Prefix:
First Name:HANA
Middle Name:H
Last Name:JUNG
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 1:1440 S STATE COLLEGE BLVD STE 5L
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5723
Mailing Address - Country:US
Mailing Address - Phone:714-936-8005
Mailing Address - Fax:
Practice Address - Street 1:1440 S STATE COLLEGE BLVD STE 5L
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5723
Practice Address - Country:US
Practice Address - Phone:714-936-8005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW57318171400000X
CA68703908133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No171400000XOther Service ProvidersHealth & Wellness Coach