Provider Demographics
NPI:1336568823
Name:JUNG, TAYLOR JIEUN (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:JIEUN
Last Name:JUNG
Suffix:
Gender:F
Credentials:MD, DDS
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:JIEUN
Other - Last Name:NORTHERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7200 HALCYON SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7047
Mailing Address - Country:US
Mailing Address - Phone:334-277-3492
Mailing Address - Fax:
Practice Address - Street 1:7200 HALCYON SUMMIT DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7047
Practice Address - Country:US
Practice Address - Phone:334-277-3492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK35599208600000X
ALD-0007005-C204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208600000XAllopathic & Osteopathic PhysiciansSurgery