Provider Demographics
NPI:1306555941
Name:JUNG, CAROL (PA-C)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 CAMPUS DRIVE SUITE A100
Mailing Address - Street 2:#5532
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92616
Mailing Address - Country:US
Mailing Address - Phone:714-987-1121
Mailing Address - Fax:
Practice Address - Street 1:13522 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3707
Practice Address - Country:US
Practice Address - Phone:714-987-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical