Provider Demographics
NPI:1932378601
Name:HUNG, JENNIFER H (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:H
Last Name:HUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 W BEVERLY BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3951
Mailing Address - Country:US
Mailing Address - Phone:323-728-7998
Mailing Address - Fax:323-728-5041
Practice Address - Street 1:2101 W BEVERLY BLVD STE 302
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3951
Practice Address - Country:US
Practice Address - Phone:323-728-2148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106918207W00000X
SC31045207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC310452Medicaid
SCAA92632326OtherMEDICARE PTAN