Provider Demographics
NPI:1417408832
Name:JUNG, PAMELA
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 EAST OHIO
Mailing Address - Street 2:UNIT 2003
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5596
Mailing Address - Country:US
Mailing Address - Phone:765-430-0211
Mailing Address - Fax:
Practice Address - Street 1:5501 W. 79TH ST.
Practice Address - Street 2:STE. 205
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1784
Practice Address - Country:US
Practice Address - Phone:708-424-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0309741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice