Provider Demographics
NPI:1811298391
Name:JUNG, CHAN SUK
Entity type:Individual
Prefix:
First Name:CHAN SUK
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 COLORADO BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1762
Mailing Address - Country:US
Mailing Address - Phone:626-676-1378
Mailing Address - Fax:213-325-6749
Practice Address - Street 1:850 COLORADO BLVD
Practice Address - Street 2:STE 104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1762
Practice Address - Country:US
Practice Address - Phone:213-553-1884
Practice Address - Fax:213-236-9662
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical