Basic Information
| Provider Information | |||||||||
| NPI: | 1811298391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUNG | ||||||||
| FirstName: | CHAN SUK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 COLORADO BLVD STE 104 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900411762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266761378 | ||||||||
| FaxNumber: | 2133256749 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 COLORADO BLVD | ||||||||
| Address2: | STE 104 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900411762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2135531884 | ||||||||
| FaxNumber: | 2132369662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2010 | ||||||||
| LastUpdateDate: | 01/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 76062 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.