Provider Demographics
NPI:1275643082
Name:JUNG, FRANK M (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
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 1:1802 YAKIMA AVE
Mailing Address - Street 2:SUITE #300
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4499
Mailing Address - Country:US
Mailing Address - Phone:253-383-5628
Mailing Address - Fax:253-383-5628
Practice Address - Street 1:1802 YAKIMA AVE
Practice Address - Street 2:SUITE #300
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4499
Practice Address - Country:US
Practice Address - Phone:253-383-5628
Practice Address - Fax:253-383-5628
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00017922174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB11663OtherMEDICARE ID
WA8448706Medicaid
WAF13718Medicare UPIN
WAAB11663Medicare PIN