Healthcare Provider Details

I. General information

NPI: 1497338040
Provider Name (Legal Business Name): KYUNG HWA JUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2021
Last Update Date: 05/02/2021
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E 23RD ST STE 220
NEW YORK NY
10010-4467
US

IV. Provider business mailing address

564 1ST AVE APT 23L
NEW YORK NY
10016-6494
US

V. Phone/Fax

Practice location:
  • Phone: 646-389-8488
  • Fax:
Mailing address:
  • Phone: 312-316-0498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZA2600X
TaxonomyMedical Art Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: