Healthcare Provider Details

I. General information

NPI: 1952896417
Provider Name (Legal Business Name): SHAWN SEOK-HUN JUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7240 E POINT DOUGLAS RD S STE 150
COTTAGE GROVE MN
55016-3021
US

IV. Provider business mailing address

6901 FLYING CLOUD DR APT 212
EDEN PRAIRIE MN
55344-4706
US

V. Phone/Fax

Practice location:
  • Phone: 651-352-4628
  • Fax:
Mailing address:
  • Phone: 630-445-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberS241
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.031676
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: