Provider Demographics
NPI:1235511171
Name:JUNG, PIUS SEONG (OD)
Entity Type:Individual
Prefix:DR
First Name:PIUS
Middle Name:SEONG
Last Name:JUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1133
Mailing Address - Country:US
Mailing Address - Phone:215-725-1209
Mailing Address - Fax:
Practice Address - Street 1:2118 COTTMAN AVE # 8
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1133
Practice Address - Country:US
Practice Address - Phone:215-725-1209
Practice Address - Fax:215-745-1373
Is Sole Proprietor?:No
Enumeration Date:2015-06-28
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014503890001Medicaid