Provider Demographics
NPI:1063856482
Name:JU, JUNG (CRNA)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:
Last Name:JU
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PINE GROVE COMMONS
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-5151
Mailing Address - Country:US
Mailing Address - Phone:717-741-5257
Mailing Address - Fax:717-741-5336
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2345
Practice Address - Fax:717-741-5336
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR177879367500000X
PARN615012367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered