Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 258700 | NY |
Y | 207W00000X | Ophthalmologist | A135262 | CA |
NPI | 1033351689 |
---|---|
Provider Name | Dr. Jesse Jung |
First Address | Oakland, CA 94609-3028 |
Second Address | Oakland, CA 94609-3028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2009 |
Last Update Date | 07/06/2015 |