MEDICARE: GRACE Y 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	363A00000X	Physician Assistant	PA18387	TX

General Provider Information

NPI Number	:	1487460671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE Y JUNG

Provider Business Mailing Address
First Line	:	5032 STEINBECK ST
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-5001
Country	:	US
Telephone Number	:	469-536-1460
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 HERITAGE TRACE PKWY STE 408
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8944
Country	:	US
Telephone Number	:	817-283-5252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2024
Last Update Date	:	12/04/2024

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