Healthcare Provider Details

I. General information

NPI: 1649864380
Provider Name (Legal Business Name): BRYAN TAEKYUNG JUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9815 MAIN ST STE 200
DAMASCUS MD
20872-2099
US

IV. Provider business mailing address

9815 MAIN ST STE 200
DAMASCUS MD
20872-2099
US

V. Phone/Fax

Practice location:
  • Phone: 301-747-6543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17688
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419913
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: