Provider Demographics
NPI:1215218722
Name:JUNG, ELIJAH JAEWOOK (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:JAEWOOK
Last Name:JUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 SYCAMORE ROAD
Mailing Address - Street 2:#A
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-9315
Mailing Address - Country:US
Mailing Address - Phone:570-323-4819
Mailing Address - Fax:
Practice Address - Street 1:1660 SYCAMORE RD
Practice Address - Street 2:#A
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-9315
Practice Address - Country:US
Practice Address - Phone:570-323-4819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0388951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice