Basic Information
| Provider Information | |||||||||
| NPI: | 1891770533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOH | ||||||||
| FirstName: | JUNG | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 N 185TH ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981334011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065421000 | ||||||||
| FaxNumber: | 2065425353 | ||||||||
| Practice Location | |||||||||
| Address1: | 1130 N 185TH ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | SHORELINE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981334011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065421000 | ||||||||
| FaxNumber: | 2065425353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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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 | 207RN0300X | MD00036853 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 8238495 | 05 | WA | MEDICAID |