MEDICARE: CALVIN JUNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	30749	TX

General Provider Information

NPI Number	:	1164886321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALVIN JUNG

Provider Business Mailing Address
First Line	:	2024 RICHMOND AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-3424
Country	:	US
Telephone Number	:	832-930-7660
Fax Number	:	832-930-7661

Provider Business Practice Location Address
First Line	:	2024 RICHMOND AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-3424
Country	:	US
Telephone Number	:	832-930-7660
Fax Number	:	832-930-7661

Authorized Official
Title or Position	:	OWNER / SURGEON
Name	:	CALVIN G JUNG
Credential	:	MD
Telephone Number	:	832-930-7660

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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