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General NPI Number Information
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NPI Number | 1356952998
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Entity Type | Individual
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Provider Name | CHRISTOPHER JUNG
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Gender | Male
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Dates
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Enumeration Date | 08/16/2020
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Last Update Date | 08/16/2020
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Provider Practice Location Address
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Address Line | 3080 N EASTMAN RD
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City | LONGVIEW
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State | TX
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Zip | 75605-5174
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Country | US
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Telephone | 8-690-3686
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 MCCANN RD APT 706
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City | LONGVIEW
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State | TX
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Zip | 75605-7854
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Country | US
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Telephone | 972-768-3968
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 36557
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License Number State | TX
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