Jae Ung Jung

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019032475 Issued in IL

Practice address

1905 W Springfield Ave
Champaign, IL 61821-3007

Phone

(888) 988-4066

NPI assigned

Jan 23, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Familia Dental Champaign LLC

  • General Practice Dentistry
  • Champaign, IL
  • NPI 1982094462
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579737600000",
    "number": "1023648664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 E ALGONQUIN RD STE 610",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 W SPRINGFIELD AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618213007",
            "telephone_number": "888-988-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUNG",
        "first_name": "JAE UNG",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-23",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019032475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Juguan, RBT
• Julen'S Opticians, Inc.
• Julie Birky Counseling PLLC
• Eui Suk Jung, DMD
• Hyunchul Jung, MD
• Aleya Justison, CD(DONA)
• Rebecca Lynn Kaefring
• Surinderpal Singh Kahlon, M.D.
• Elizabeth Kaiser
• Eleni Isabel Kaitson, LSW

• General Practice Dentistry in Champaign, IL
• Providers in Champaign, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.