Provider Demographics
NPI:1275518573
Name:JUNG, HAEOH M (MD)
Entity Type:Individual
Prefix:
First Name:HAEOH
Middle Name:M
Last Name:JUNG
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 1:930 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:KINZERS
Mailing Address - State:PA
Mailing Address - Zip Code:17535-9620
Mailing Address - Country:US
Mailing Address - Phone:215-858-0203
Mailing Address - Fax:
Practice Address - Street 1:325 S BELMONT ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2608
Practice Address - Country:US
Practice Address - Phone:717-843-8623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058147L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001625437Medicaid
PA662325Medicare PIN
PAG58494Medicare UPIN