Provider Demographics
NPI:1235535675
Name:JUNG, SEUNGHUN (DC)
Entity Type:Individual
Prefix:DR
First Name:SEUNGHUN
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 E WIND DR
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-9454
Mailing Address - Country:US
Mailing Address - Phone:209-284-3342
Mailing Address - Fax:209-645-7849
Practice Address - Street 1:274 E WIND DR
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-9454
Practice Address - Country:US
Practice Address - Phone:209-284-3342
Practice Address - Fax:209-645-7849
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 32200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 32200Medicare PIN