Healthcare Provider Details

I. General information

NPI: 1346159183
Provider Name (Legal Business Name): JOHN JUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 MOUNTAIN VIEW DR
AUSTIN TX
78704-4638
US

IV. Provider business mailing address

2507 MOUNTAIN VIEW DR
AUSTIN TX
78704-4638
US

V. Phone/Fax

Practice location:
  • Phone: 917-330-7182
  • Fax:
Mailing address:
  • Phone: 917-330-7182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1123433
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: