Provider Demographics
NPI:1740281955
Name:KU, MIN JUNG (MD)
Entity type:Individual
Prefix:
First Name:MIN
Middle Name:JUNG
Last Name:KU
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD STE 400
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5107
Mailing Address - Country:US
Mailing Address - Phone:914-984-2546
Mailing Address - Fax:
Practice Address - Street 1:2300 COMPUTER RD STE E25
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1737
Practice Address - Country:US
Practice Address - Phone:215-659-5480
Practice Address - Fax:215-659-5482
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07702500207K00000X
PAMD424863207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA341349JSWMedicare PIN
NJI13765Medicare UPIN