Provider Demographics
NPI:1508451063
Name:JUNG, CHANGHYUN (DDS)
Entity Type:Individual
Prefix:
First Name:CHANGHYUN
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHANGHYUN
Other - Middle Name:
Other - Last Name:JUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:107 VAILCO LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6565
Mailing Address - Country:US
Mailing Address - Phone:805-835-5134
Mailing Address - Fax:
Practice Address - Street 1:3724 JEFFERSON ST STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6219
Practice Address - Country:US
Practice Address - Phone:512-452-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1005932261QD0000X
TX369711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental