Provider Demographics
NPI:1003915109
Name:JUNG JANG HWAN, MD
Entity Type:Organization
Organization Name:JUNG JANG HWAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:J
Authorized Official - Last Name:HWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-587-4394
Mailing Address - Street 1:709 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9139
Mailing Address - Country:US
Mailing Address - Phone:570-587-4394
Mailing Address - Fax:
Practice Address - Street 1:709 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9139
Practice Address - Country:US
Practice Address - Phone:570-587-4394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033267L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006014770003Medicaid
PA130727Medicare ID - Type Unspecified
PA0006014770003Medicaid