Provider Demographics
NPI:1811218290
Name:JUNG, JENNIFER KO (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KO
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 1:1315 ST JOSEPH PKWY STE 806
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8230
Mailing Address - Country:US
Mailing Address - Phone:713-650-6556
Mailing Address - Fax:713-650-8539
Practice Address - Street 1:1315 ST JOSEPH PKWY STE 806
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8230
Practice Address - Country:US
Practice Address - Phone:713-756-4780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-19
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27955207Q00000X
390200000X
TXR4405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program