Provider Demographics
NPI:1689092702
Name:JUNG, JIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JIN
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
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:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-0479
Mailing Address - Country:US
Mailing Address - Phone:609-914-7017
Mailing Address - Fax:609-261-4180
Practice Address - Street 1:210 ARK RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3188
Practice Address - Country:US
Practice Address - Phone:609-261-4500
Practice Address - Fax:609-261-4180
Is Sole Proprietor?:No
Enumeration Date:2014-04-05
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA106374002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0729281Medicaid