Provider Demographics
NPI:1326150194
Name:JUNG, SANGWON (DC)
Entity Type:Individual
Prefix:
First Name:SANGWON
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9020 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1514
Mailing Address - Country:US
Mailing Address - Phone:301-468-3434
Mailing Address - Fax:240-223-2502
Practice Address - Street 1:9020 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1514
Practice Address - Country:US
Practice Address - Phone:301-468-3434
Practice Address - Fax:240-223-2502
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD502086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG7310001OtherCAREFIRST BCBS
MD404059700Medicaid
MDKDN25AOtherCAREFIRST BCBS
MD617750OtherCAREFIRST BCBS
MD491408Medicare PIN