Healthcare Provider Details

I. General information

NPI: 1821201898
Provider Name (Legal Business Name): MICHAEL C JUNG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST GRB 273A
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT STREET GRB 273A
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-8320
  • Fax: 617-724-3338
Mailing address:
  • Phone: 617-726-8320
  • Fax: 617-724-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA94943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: