Healthcare Provider Details

I. General information

NPI: 1255190708
Provider Name (Legal Business Name): KYUNG JU JUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 ELECTRIC RD
SALEM VA
24153-7494
US

IV. Provider business mailing address

1900 ELECTRIC RD
SALEM VA
24153-7474
US

V. Phone/Fax

Practice location:
  • Phone: 540-776-4000
  • Fax:
Mailing address:
  • Phone: 540-776-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0102210168
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: