Provider Demographics
NPI:1174758916
Name:JUNG, SAMUEL CHIHO
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CHIHO
Last Name:JUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 E. BASTANCHURY ROAD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2782
Mailing Address - Country:US
Mailing Address - Phone:714-672-9445
Mailing Address - Fax:714-672-9448
Practice Address - Street 1:1441 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:323-727-2992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7369237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist