Healthcare Provider Details

I. General information

NPI: 1821777202
Provider Name (Legal Business Name): SEUNG WON JUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date: 02/20/2024
Reactivation Date: 09/11/2025

III. Provider practice location address

35 PANGBORN PL
HACKENSACK NJ
07601-4560
US

IV. Provider business mailing address

35 PANGBORN PL
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 212-998-9800
  • Fax:
Mailing address:
  • Phone: 212-998-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03108000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: