Provider Demographics
NPI:1952861221
Name:TIEN, JUNG-JUNG KAREN (MD)
Entity Type:Individual
Prefix:
First Name:JUNG-JUNG
Middle Name:KAREN
Last Name:TIEN
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 1:6850 LAKE NONA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827
Mailing Address - Country:US
Mailing Address - Phone:321-697-1730
Mailing Address - Fax:407-518-3923
Practice Address - Street 1:6850 LAKE NONA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827
Practice Address - Country:US
Practice Address - Phone:321-697-1730
Practice Address - Fax:407-518-3923
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2022-08-08
Deactivation Date:2019-11-27
Deactivation Code:
Reactivation Date:2020-02-11
Provider Licenses
StateLicense IDTaxonomies
FLME154428207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine