Provider Demographics
NPI:1215345897
Name:JUNG, YUJIN (DDS)
Entity type:Individual
Prefix:
First Name:YUJIN
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13626 WARWICK BLVD
Mailing Address - Street 2:#A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-5566
Mailing Address - Country:US
Mailing Address - Phone:757-833-7217
Mailing Address - Fax:
Practice Address - Street 1:13626 WARWICK BLVD
Practice Address - Street 2:#A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-5566
Practice Address - Country:US
Practice Address - Phone:757-833-7217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist