Provider Demographics
NPI:1952631798
Name:TAI, JUNG (DDS)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:
Last Name:TAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JUNG-KUAN
Other - Middle Name:
Other - Last Name:TAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:57 W 57TH ST
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2802
Mailing Address - Country:US
Mailing Address - Phone:212-307-0940
Mailing Address - Fax:212-307-0945
Practice Address - Street 1:57 W 57TH ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:212-307-0940
Practice Address - Fax:212-307-0945
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist