Provider Demographics
NPI:1164313458
Name:JUNG, CHARISSA MAMIE
Entity type:Individual
Prefix:
First Name:CHARISSA
Middle Name:MAMIE
Last Name:JUNG
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39675 CEDAR BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5364
Mailing Address - Country:US
Mailing Address - Phone:510-877-0686
Mailing Address - Fax:
Practice Address - Street 1:39675 CEDAR BLVD STE 260
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5364
Practice Address - Country:US
Practice Address - Phone:510-877-0686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67112355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant