Provider Demographics
NPI:1902862683
Name:JUNG, DAVID D (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:JUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4231
Practice Address - Street 1:629 N SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-1821
Practice Address - Country:US
Practice Address - Phone:419-562-4677
Practice Address - Fax:419-562-0987
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005572207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0670591Medicaid
OHP00280534OtherRR MEDICARE FOR GALION
OH000000325328OtherBCBS FOR BUCYRUS
OH110234239OtherRR MEDICARE FOR MARION
P00090171OtherRR MEDICARE FOR BUCYRUS
OH000000384390OtherBCBS # FOR GALION
OH0670591Medicaid
OH000000325328OtherBCBS FOR BUCYRUS
OHJU0814398Medicare ID - Type UnspecifiedMEDICARE # FOR GALION
F45232Medicare UPIN