Provider Demographics
NPI:1306021878
Name:TAE JUNG M.D., INC.
Entity Type:Organization
Organization Name:TAE JUNG M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAE
Authorized Official - Middle Name:HUI
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-382-0388
Mailing Address - Street 1:15424 SPRUCEVALE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9200
Mailing Address - Country:US
Mailing Address - Phone:330-382-0388
Mailing Address - Fax:330-382-0389
Practice Address - Street 1:15424 SPRUCEVALE RD
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9200
Practice Address - Country:US
Practice Address - Phone:330-382-0388
Practice Address - Fax:330-382-0389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078382J207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1306021878OtherNPI GROUP NUMBER
OHSP00791OtherMEDICARE GROUP NUMBER
OH2205527Medicaid
OH2205527Medicaid