Provider Demographics
NPI:1023399755
Name:JUNG, HANUL (PTA, LAC)
Entity Type:Individual
Prefix:
First Name:HANUL
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:PTA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14428 HOMECREST RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1820
Mailing Address - Country:US
Mailing Address - Phone:240-506-6549
Mailing Address - Fax:
Practice Address - Street 1:14428 HOMECREST RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1820
Practice Address - Country:US
Practice Address - Phone:240-506-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000988171100000X
VA2306603843225200000X
MDA3686225200000X
MDU02656171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA3686Medicaid
MDU02656OtherDHMH