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General NPI Number Information
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NPI Number | 1497869606
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Entity Type | Individual
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Provider Name | MELVIN SHAO YUN JUNG DMD FAAPD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 3985 OKEMOS RD
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City | OKEMOS
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State | MI
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Zip | 48864
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Country | US
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Telephone | 517-381-5244
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Fax | 517-381-5247
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Provider Business Mailing Address
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Address Line | 3985 OKEMOS RD
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City | OKEMOS
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State | MI
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Zip | 48864
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Country | US
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Telephone | 517-381-5244
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Fax | 517-381-5247
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2901016811
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License Number State | MI
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