1336393503 NPI number — MRS. JULIANNA C LUNG HIS

Table of content: MRS. JULIANNA C LUNG HIS (NPI 1336393503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336393503 NPI number — MRS. JULIANNA C LUNG HIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUNG
Provider First Name:
JULIANNA
Provider Middle Name:
C
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
HIS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336393503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7424 JACKSON DR
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92119-2324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-741-4905
Provider Business Mailing Address Fax Number:
619-741-4380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7424 JACKSON DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92119-2324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-741-4905
Provider Business Practice Location Address Fax Number:
619-741-4380
Provider Enumeration Date:
11/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  HA7078 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)