Provider Demographics
NPI:1508360439
Name:JUNG, JENNA HYEONSOO (MD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:HYEONSOO
Last Name:JUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5986
Mailing Address - Country:US
Mailing Address - Phone:718-971-9095
Mailing Address - Fax:718-584-5869
Practice Address - Street 1:1017 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5986
Practice Address - Country:US
Practice Address - Phone:718-971-9095
Practice Address - Fax:718-584-5869
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309501207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics