Provider Demographics
NPI:1083803407
Name:JUNG, MICHELLE MISOOK (AC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MISOOK
Last Name:JUNG
Suffix:
Gender:F
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18800 PRESTON RD
Mailing Address - Street 2:SUITE 313
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2449
Mailing Address - Country:US
Mailing Address - Phone:972-769-2225
Mailing Address - Fax:972-769-0384
Practice Address - Street 1:18800 PRESTON RD
Practice Address - Street 2:SUITE 313
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-2449
Practice Address - Country:US
Practice Address - Phone:972-769-2225
Practice Address - Fax:972-769-0384
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00883171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist