Active NPI
Peter Su Jung, DC
- Chiropractor
- Anaheim, CA
National Provider Identifier
1578648358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC25977
- Practice address
- 520 N Brookhurst St
# 102
Anaheim, CA 92801-5227 - Phone
- (714) 817-7444
- Fax
- (888) 234-2363
- NPI assigned
- Oct 27, 2006
- Last updated
- Mar 22, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC25977 | CA | Primary |
Addresses
Primary practice location
520 N Brookhurst St
# 102
Anaheim, CA 92801-5227
Mailing address
520 N Brookhurst St
# 102
Anaheim, CA 92801-5227
Phone (714) 817-7444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11560202 | Other | CA | QH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC25977 | CA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jung Chiropractic Corporation | Chiropractor | Past | Accepting new patients |
| Nuvida KMC | Chiropractor | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Chiropractor
- Anaheim, CA
- NPI 1326383670
-
- Chiropractor
- Anaheim, CA
- NPI 1508019498
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490140800000",
"number": "1578648358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "520 N BROOKHURST ST",
"address_2": "# 102",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928015227",
"telephone_number": "714-817-7444",
"fax_number": "888-234-2363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 N BROOKHURST ST",
"address_2": "# 102",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928015227",
"telephone_number": "714-817-7444",
"fax_number": "888-234-2363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUNG",
"first_name": "PETER",
"middle_name": "SU",
"name_prefix": "Mr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-27",
"last_updated": "2017-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC25977",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QH",
"identifier": "11560202",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.