Provider Demographics
NPI:1902954134
Name:JUNG, PETER BYUNGCHUL (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:BYUNGCHUL
Last Name:JUNG
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:18600 S FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4505
Mailing Address - Country:US
Mailing Address - Phone:626-833-5455
Mailing Address - Fax:310-645-1443
Practice Address - Street 1:7101 LA TIJERA BLVD
Practice Address - Street 2:# J-102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2174
Practice Address - Country:US
Practice Address - Phone:626-833-5455
Practice Address - Fax:310-645-1443
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11665T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist