Provider Demographics
NPI:1598106569
Name:JUNG, JAE HA (D D S)
Entity Type:Individual
Prefix:
First Name:JAE HA
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 U.S. 287 FRONTAGE RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063
Mailing Address - Country:US
Mailing Address - Phone:817-313-3760
Mailing Address - Fax:
Practice Address - Street 1:1710 U.S. 287 FRONTAGE RD
Practice Address - Street 2:STE 100
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:817-313-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX323661223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics