Provider Demographics
NPI:1326492885
Name:SAMUEL T. JUNG D.D.S., P.C.
Entity Type:Organization
Organization Name:SAMUEL T. JUNG D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-359-4433
Mailing Address - Street 1:13511 40TH RD
Mailing Address - Street 2:#4E
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5323
Mailing Address - Country:US
Mailing Address - Phone:718-359-4433
Mailing Address - Fax:
Practice Address - Street 1:13511 40TH RD
Practice Address - Street 2:#4E
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5323
Practice Address - Country:US
Practice Address - Phone:718-359-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0418391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty