Provider Demographics
NPI:1295859718
Name:JUNG, JUNHO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUNHO
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 LEMOINE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5608
Mailing Address - Country:US
Mailing Address - Phone:201-625-3210
Mailing Address - Fax:518-537-6334
Practice Address - Street 1:1550 LEMOINE AVE STE 203
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5608
Practice Address - Country:US
Practice Address - Phone:201-625-3210
Practice Address - Fax:201-947-2909
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0510401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02634917Medicaid