Provider Demographics
NPI:1770258931
Name:UNG, DEBBIE ANN (OD)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:ANN
Last Name:UNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3488 E TEMPLE WAY # 20
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-2329
Mailing Address - Country:US
Mailing Address - Phone:213-327-6528
Mailing Address - Fax:
Practice Address - Street 1:28901 S WESTERN AVE STE 129
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0824
Practice Address - Country:US
Practice Address - Phone:310-221-3676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist