Provider Demographics
NPI:1306393475
Name:JUNG, GYUNGSIK
Entity Type:Individual
Prefix:
First Name:GYUNGSIK
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9260 W SUNSET RD STE 204
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4903
Mailing Address - Country:US
Mailing Address - Phone:702-595-4134
Mailing Address - Fax:
Practice Address - Street 1:9260 W SUNSET RD STE 204
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4903
Practice Address - Country:US
Practice Address - Phone:702-595-4134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist