Provider Demographics
NPI:1780789230
Name:MIN, JUNG T (MD)
Entity type:Individual
Prefix:DR
First Name:JUNG
Middle Name:T
Last Name:MIN
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 1:246 FRIENDSHIP CIR
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-9713
Mailing Address - Country:US
Mailing Address - Phone:724-773-5207
Mailing Address - Fax:
Practice Address - Street 1:246 FRIENDSHIP CIR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9713
Practice Address - Country:US
Practice Address - Phone:724-773-5207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034115L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA98652300005Medicaid
PAC28465Medicare UPIN
PA051675Medicare ID - Type Unspecified