Provider Demographics
NPI:1871067462
Name:JUNG, HAN A
Entity type:Individual
Prefix:
First Name:HAN
Middle Name:A
Last Name:JUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CALLAN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4523
Mailing Address - Country:US
Mailing Address - Phone:844-828-2254
Mailing Address - Fax:
Practice Address - Street 1:101 CALLAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4523
Practice Address - Country:US
Practice Address - Phone:844-828-2254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1580203Medicaid