Provider Demographics
NPI:1386856318
Name:JUNG, SHINWOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHINWOO
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 100TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2733
Mailing Address - Country:US
Mailing Address - Phone:253-582-5050
Mailing Address - Fax:253-582-5399
Practice Address - Street 1:6001 100TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2733
Practice Address - Country:US
Practice Address - Phone:253-582-5050
Practice Address - Fax:253-582-5399
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA108021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice