Provider Demographics
NPI:1992677793
Name:JUNG, JACQUELINE M (LAC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:JUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 NUUANU AVE APT 431
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3778
Mailing Address - Country:US
Mailing Address - Phone:808-397-4169
Mailing Address - Fax:
Practice Address - Street 1:1511 NUUANU AVE APT 431
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3778
Practice Address - Country:US
Practice Address - Phone:808-397-4169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-1326171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist