Provider Demographics
NPI:1801778519
Name:SONG, JUNG GUN (OTR/L)
Entity type:Individual
Prefix:
First Name:JUNG GUN
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18255 LA GUARDIA ST
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4422
Mailing Address - Country:US
Mailing Address - Phone:818-296-9153
Mailing Address - Fax:
Practice Address - Street 1:18255 LA GUARDIA ST
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-4422
Practice Address - Country:US
Practice Address - Phone:818-296-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20031225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty