Provider Demographics
NPI:1508346685
Name:JUNG, MI YOUNG (FNP)
Entity Type:Individual
Prefix:
First Name:MI YOUNG
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 S BUCKNER BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-6950
Mailing Address - Country:US
Mailing Address - Phone:214-206-4974
Mailing Address - Fax:
Practice Address - Street 1:2959 S BUCKNER BLVD STE 700
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-6950
Practice Address - Country:US
Practice Address - Phone:214-206-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX910291163W00000X
TX1130139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse