Provider Demographics
NPI:1487460671
Name:JUNG, GRACE Y
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:Y
Last Name:JUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5032 STEINBECK ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-5001
Mailing Address - Country:US
Mailing Address - Phone:469-536-1460
Mailing Address - Fax:
Practice Address - Street 1:4444 HERITAGE TRACE PKWY STE 408
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8944
Practice Address - Country:US
Practice Address - Phone:817-283-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18387363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant