Provider Demographics
NPI:1497244644
Name:JUNG, SEONGHAK (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SEONGHAK
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 NACOGDOCHES
Mailing Address - Street 2:6
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 NACOGDOCHES
Practice Address - Street 2:6
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935
Practice Address - Country:US
Practice Address - Phone:202-361-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT73382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer