Provider Demographics
NPI:1962073064
Name:JUNG, ALEX Y
Entity type:Individual
Prefix:
First Name:ALEX
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 1:2947 SILVERMERE LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4325
Mailing Address - Country:US
Mailing Address - Phone:619-993-4451
Mailing Address - Fax:
Practice Address - Street 1:2947 SILVERMERE LN
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4325
Practice Address - Country:US
Practice Address - Phone:619-993-4451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician