Healthcare Provider Details

I. General information

NPI: 1790367845
Provider Name (Legal Business Name): SEUNGMIN JUNG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS JUNG DPT

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 SHERMAN AVE STE 204
EVANSTON IL
60201-3771
US

IV. Provider business mailing address

1830 SHERMAN AVE STE 204
EVANSTON IL
60201-3771
US

V. Phone/Fax

Practice location:
  • Phone: 201-566-4407
  • Fax:
Mailing address:
  • Phone: 201-566-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070025676
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: