Basic Information
| Provider Information | |||||||||
| NPI: | 1932210432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUNGLAS | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DRIVE | ||||||||
| Address2: | CREDENTIALING DEPARTMENT | ||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163792912 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 Q STREET | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167333333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 03/08/2012 | ||||||||
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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 | 207X00000X | G87338 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 248481 | 01 | CA | INTERPLAN | OTHER | 90143890 | 01 | CA | PACIFICARE | OTHER | MCMG362100 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | 4122848 | 01 | CA | AETNA | OTHER | 107927 | 01 | CA | HEALTH NET | OTHER | 1619015 | 01 | CA | GREAT WEST | OTHER | 00G873380 | 05 | CA | MEDICAID | 1130332 | 01 | CA | UNITED HEALTHCARE | OTHER | 87347 | 01 | CA | FIRST HEALTH | OTHER | G87338 | 01 | CA | BLUE CROSS | OTHER | 00G873380 | 01 | CA | BLUE SHIELD | OTHER | 1859557 | 01 | CA | CIGNA | OTHER |