Basic Information
| Provider Information | |||||||||
| NPI: | 1346203668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUN | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | NAM-KYU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927013640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144806767 | ||||||||
| FaxNumber: | 7145684362 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 N MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927013640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144806767 | ||||||||
| FaxNumber: | 7145684362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2006 | ||||||||
| LastUpdateDate: | 07/11/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | A34045 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | A34045 | 01 | CA | CALIFORNIA STATE LICENSE | OTHER |