Provider Demographics
NPI:1427630557
Name:JUNG, SUNG MIN (DMD)
Entity type:Individual
Prefix:DR
First Name:SUNG
Middle Name:MIN
Last Name:JUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 CHAPMAN LOOP
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-1731
Mailing Address - Country:US
Mailing Address - Phone:425-941-0013
Mailing Address - Fax:
Practice Address - Street 1:5605 LAKEWOOD TOWNE CENTER BLVD SW STE B
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3855
Practice Address - Country:US
Practice Address - Phone:253-200-4049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA610679571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice