Provider Demographics
NPI:1346474574
Name:JUNG, MINCHUL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MINCHUL
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 HOWE AVE
Mailing Address - Street 2:C3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4670
Mailing Address - Country:US
Mailing Address - Phone:916-972-1615
Mailing Address - Fax:916-972-1615
Practice Address - Street 1:701 HOWE AVE
Practice Address - Street 2:C3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4670
Practice Address - Country:US
Practice Address - Phone:916-972-1615
Practice Address - Fax:916-972-1615
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist