Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 30563 | CA |
NPI | 1205079795 |
---|---|
Provider Name | Edward Jung |
First Address | Granada Hills, CA 91344-7379 |
Second Address | Granada Hills, CA 91344-7379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2009 |
Last Update Date | 03/12/2009 |