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NPI Code Detail

MEDICARE: DR. PIUS SEONG JUNG O.D.

MEDICARE: DR. PIUS SEONG JUNG O.D.
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
1152W00000XOptometristOEG003065PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235511171
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PIUS SEONG JUNG O.D.
Provider Business Mailing Address
First Line : 2118 COTTMAN AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-1133
Country : US
Telephone Number : 215-725-1209
Fax Number :
Provider Business Practice Location Address
First Line : 2118 COTTMAN AVE # 8
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-1133
Country : US
Telephone Number : 215-725-1209
Fax Number : 215-745-1373
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2015
Last Update Date : 12/03/2020

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