MEDICARE: DR. CALVIN G JUNG MD, DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	30749	TX
2	208600000X	Surgery Physician	Q6332	TX

General Provider Information

NPI Number	:	1093978710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CALVIN G JUNG MD, DDS

Provider Business Mailing Address
First Line	:	2024 RICHMOND AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4747
Country	:	US
Telephone Number	:	832-930-7660
Fax Number	:

Provider Business Practice Location Address
First Line	:	2024 RICHMOND AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4747
Country	:	US
Telephone Number	:	832-930-7660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	10/10/2016

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