Healthcare Provider Details

I. General information

NPI: 1720331333
Provider Name (Legal Business Name): ALLISON B JUNG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17969 HASKINS RD
CHAGRIN FALLS OH
44023-1613
US

IV. Provider business mailing address

17969 HASKINS RD
CHAGRIN FALLS OH
44023-1613
US

V. Phone/Fax

Practice location:
  • Phone: 985-705-1081
  • Fax:
Mailing address:
  • Phone: 985-705-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number14271263-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number110011733
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.010433
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8081901
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA0009722
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2026006929
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11638
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number85.012007
License Number StateIL
# 9
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2830
License Number StateAL
# 10
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9121415
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: