Basic Information
| Provider Information | |||||||||
| NPI: | 1528009503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUNG | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 101018 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911891018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125830205 | ||||||||
| FaxNumber: | 5125832001 | ||||||||
| Practice Location | |||||||||
| Address1: | 618 5TH ST | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959015612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307494400 | ||||||||
| FaxNumber: | 5307494534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 12/10/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | RHL103258 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 00G404830 | 05 | CA | MEDICAID | AJ7250311 | 01 | DEA | OTHER | G40483 | 01 | CA | MEDICAL LICENSE | OTHER |