Provider Demographics
NPI:1114928553
Name:HWAN, JUNG JANG (MD)
Entity Type:Individual
Prefix:DR
First Name:JUNG
Middle Name:JANG
Last Name:HWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:570-587-0300
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:570-587-0300
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01060147703Medicaid
PAHN130727Medicare ID - Type Unspecified
PA01060147703Medicaid