Physician Compare National (NPI:1831153006)

HEALTHCARE PROVIDER: TAE H JUNG M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1831153006
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577648286
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080305000395
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JUNG
	Individual professional last name
Provider First Name	TAE
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1998
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	TAE JUNG M.D., INC.
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	6204911928
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	15424 SPRUCEVALE RD
	Group Practice or individual's line 1 address
City	EAST LIVERPOOL
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	439209200
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3303820388
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360096
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	EAST LIVERPOOL CITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	390036
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	HERITAGE VALLEY BEAVER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	360211
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	TRINITY MEDICAL CTR EAST &TRINITY MEDICAL CTR WEST
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	360185
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	SALEM REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y