Provider Demographics
NPI:1548828049
Name:JUNG, MING (PHARMD)
Entity type:Individual
Prefix:
First Name:MING
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 LEISURE TOWN RD APT 90
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9445
Mailing Address - Country:US
Mailing Address - Phone:626-679-5287
Mailing Address - Fax:
Practice Address - Street 1:10355 WICKLOW WAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-9324
Practice Address - Country:US
Practice Address - Phone:209-223-5193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist