Healthcare Provider Details

I. General information

NPI: 1215516059
Provider Name (Legal Business Name): JUNG GI MIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 29TH ST
BILLINGS MT
59101-0905
US

IV. Provider business mailing address

PO BOX 35100
BILLINGS MT
59107-5100
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-5046
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA192002
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMED-RES-LIC-142245
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: