Provider Demographics
NPI:1669701116
Name:JUN, SANG H (RD,CC,CSO)
Entity type:Individual
Prefix:MISS
First Name:SANG
Middle Name:H
Last Name:JUN
Suffix:
Gender:F
Credentials:RD,CC,CSO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S FIGUEROA ST APT 616A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-5410
Mailing Address - Country:US
Mailing Address - Phone:213-453-1001
Mailing Address - Fax:
Practice Address - Street 1:123 S FIGUEROA ST APT 616A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-5410
Practice Address - Country:US
Practice Address - Phone:213-453-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA959615133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered