Provider Demographics
NPI:1477812758
Name:JUNG, JU HYUNG (PT)
Entity Type:Individual
Prefix:
First Name:JU HYUNG
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7290 SAMUEL DR STE 205
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-2796
Mailing Address - Country:US
Mailing Address - Phone:303-430-6475
Mailing Address - Fax:303-426-3209
Practice Address - Street 1:7290 SAMUEL DR STE 205
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2796
Practice Address - Country:US
Practice Address - Phone:303-430-6475
Practice Address - Fax:303-426-3209
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19559275Medicaid