Healthcare Provider Details

I. General information

NPI: 1508624867
Provider Name (Legal Business Name): JINYOUNG JUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 NE 66TH ST APT W111
SEATTLE WA
98195-6365
US

IV. Provider business mailing address

802 NE 66TH ST APT W111
SEATTLE WA
98195-6365
US

V. Phone/Fax

Practice location:
  • Phone: 520-380-8834
  • Fax:
Mailing address:
  • Phone: 520-380-8834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number70006843
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: