Provider Demographics
NPI:1932210432
Name:JUNGLAS, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:JUNGLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DRIVE
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2912
Mailing Address - Fax:
Practice Address - Street 1:3000 Q STREET
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87338207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA248481OtherINTERPLAN
CA90143890OtherPACIFICARE
CAMCMG362100OtherWESTERN HEALTH ADVANTAGE
CA4122848OtherAETNA
CA107927OtherHEALTH NET
CA1619015OtherGREAT WEST
CA00G873380Medicaid
CA1130332OtherUNITED HEALTHCARE
CA87347OtherFIRST HEALTH
CAG87338OtherBLUE CROSS
CA00G873380OtherBLUE SHIELD
CA1859557OtherCIGNA
CA248481OtherINTERPLAN
CA4122848OtherAETNA