Provider Demographics
NPI:1871207738
Name:JUNG, JUNGIN (ATC)
Entity type:Individual
Prefix:
First Name:JUNGIN
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CLARK ST APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-7503
Mailing Address - Country:US
Mailing Address - Phone:405-714-4370
Mailing Address - Fax:
Practice Address - Street 1:8 CLARK ST APT 2D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-7503
Practice Address - Country:US
Practice Address - Phone:405-714-4370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000003082OtherNATIONAL ATHLETIC TRAINER ASSOCIATION