Basic Information
| Provider Information | |||||||||
| NPI: | 1629516539 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUNG | ||||||||
| FirstName: | SEUNG MIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PURGIOCITY 1 CHA, 2 JEONGJA RO, BUNDANG GU | ||||||||
| Address2: | APT #2104 | ||||||||
| City: | SEONGNAM SI | ||||||||
| State: | GYUNGGI DO | ||||||||
| PostalCode: | 13560 | ||||||||
| CountryCode: | KR | ||||||||
| TelephoneNumber: | 821088198070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 E 210TH ST | ||||||||
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| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104672412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189204806 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2017 | ||||||||
| LastUpdateDate: | 03/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 122300000X | DD4843 | NM | Y | Dental Providers | Dentist |
No ID Information.