Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | A91012 | CA |
N | 2081P2900X | Pain Medicine | A91012 | CA |
NPI | 1184810707 |
---|---|
Provider Name | Jae Jung |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90024-6970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2007 |
Last Update Date | 15/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A910120 | (05) | CA |