Provider Demographics
NPI:1902032055
Name:JUNG WU M.D., P.C.
Entity Type:Organization
Organization Name:JUNG WU M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D., P.C., PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-546-7410
Mailing Address - Street 1:1325 BYRON RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1078
Mailing Address - Country:US
Mailing Address - Phone:517-546-7410
Mailing Address - Fax:517-546-4020
Practice Address - Street 1:1325 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1078
Practice Address - Country:US
Practice Address - Phone:517-546-7410
Practice Address - Fax:517-546-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036226207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1097059Medicaid
0470259Medicare PIN