Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A90948 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A90948 | CA |
N | 213ES0103X | Foot & Ankle Surgery | A90948 | CA |
NPI | 1417925462 |
---|---|
Provider Name | Mr. Kenneth S. Jung II |
First Address | Los Angeles, CA 90045 |
Second Address | Los Angeles, CA 90045-1543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 27/08/2021 |