Active NPI
Miranda Hoffman Jung, PSYD
- Clinical Psychologist
- Berkeley, CA
National Provider Identifier
1871776161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY19370
- Practice address
- 2340 Ward St Ste 101
Berkeley, CA 94705 - Phone
- (510) 917-5419
- Fax
- (949) 553-6709
- NPI assigned
- Dec 10, 2007
- Last updated
- Nov 27, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY19370 | CA | Primary |
Addresses
Primary practice location
2340 Ward St Ste 101
Berkeley, CA 94705
Mailing address
2340 Ward St Ste 101
Berkeley, CA 94705-1146
Phone (510) 917-5419
Other practice location 1
3873 Howe St
Oakland, CA 94611
Phone (510) 917-5419
Other practice location 2
3873 Howe St
Oakland, CA 94611
Phone (510) 917-5419
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2021 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY19370 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543276800000",
"number": "1871776161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2340 WARD ST STE 101",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947051146",
"telephone_number": "510-917-5419",
"fax_number": "949-553-6709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2340 WARD ST STE 101",
"city": "BERKELEY",
"state": "CA",
"postal_code": "94705",
"telephone_number": "510-917-5419",
"fax_number": "949-553-6709"
}
],
"practiceLocations": [
{
"address_1": "3873 Howe St",
"address_purpose": "LOCATION",
"city": "Oakland",
"state": "CA",
"postal_code": "94611",
"country_code": "US",
"telephone_number": "510-917-5419",
"fax_number": "949-553-6709",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3873 Howe St",
"address_purpose": "LOCATION",
"city": "Oakland",
"state": "CA",
"postal_code": "94611",
"country_code": "US",
"telephone_number": "510-917-5419",
"fax_number": "949-553-6709",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JUNG",
"first_name": "MIRANDA",
"middle_name": "HOFFMAN",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-10",
"last_updated": "2018-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY19370",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.