Provider Demographics
NPI:1063741502
Name:HUH, JENNIE JUNG (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:JUNG
Last Name:HUH
Suffix:
Gender:F
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 1:13229 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-8135
Mailing Address - Country:US
Mailing Address - Phone:909-628-4907
Mailing Address - Fax:
Practice Address - Street 1:13229 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-8135
Practice Address - Country:US
Practice Address - Phone:909-628-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1350225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics