MEDICARE: KI SOO JUNG MD

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	2084N0400X	Neurology Physician	200400364	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00387970	OTHER	NC	RAILROAD MEDICARE
2	Q00247071	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609862283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KI SOO JUNG MD

Provider Business Mailing Address
First Line	:	225 BALDWIN AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3109
Country	:	US
Telephone Number	:	704-376-1605
Fax Number	:	704-335-8448

Provider Business Practice Location Address
First Line	:	10314 HAMPTONS PARK DR
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7217
Country	:	US
Telephone Number	:	704-831-4100
Fax Number	:	704-831-4105

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	03/20/2024

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Directions to “ KI SOO JUNG MD” Practice Location

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