Provider Demographics
NPI:1720501240
Name:LI, JUNG H (NP-BC)
Entity type:Individual
Prefix:
First Name:JUNG
Middle Name:H
Last Name:LI
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:JUNG
Other - Middle Name:H
Other - Last Name:WHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:ATTN: JUNG LI
Mailing Address - Street 2:23456 HAWTHORNE BLVD STE 300
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4716
Mailing Address - Country:US
Mailing Address - Phone:310-539-2055
Mailing Address - Fax:
Practice Address - Street 1:23456 HAWTHORNE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4716
Practice Address - Country:US
Practice Address - Phone:310-539-2055
Practice Address - Fax:310-530-3263
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA735634163W00000X
CA95008758363L00000X, 363L00000X
NY700157163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse