MEDICARE: CHARLES J. JUNG, DMD, A PROFESSIONAL CORP.

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	1223G0001X	General Practice Dentistry	34128	CA

General Provider Information

NPI Number	:	1265511679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES J. JUNG, DMD, A PROFESSIONAL CORP.

Provider Business Mailing Address
First Line	:	1830 W PICO BLVD STE A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-5018
Country	:	US
Telephone Number	:	213-380-2646
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-5018
Country	:	US
Telephone Number	:	213-380-2646
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES J. JUNG
Credential	:	D.M.D.
Telephone Number	:	213-380-2646

Provider Enumeration Date	:	11/05/2006
Last Update Date	:	10/09/2014

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