Edmund Jung

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1687 Issued in WI

Practice address

3715 Washington Rd
Kenosha, WI 53144-1629

Phone

(262) 654-6800

Fax

(262) 657-9995

NPI assigned

Jan 1, 2007

Sex

Male

Sole proprietor

No

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

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Wisconsin Dental Group, S.C.

  • General Practice Dentistry
  • Kenosha, WI
  • NPI 1437289006
  NPD (past)

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

{
    "created_epoch": "1167609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053478115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3715 WASHINGTON RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441629",
            "telephone_number": "262-654-6800",
            "fax_number": "262-657-9995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3715 WASHINGTON RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441629",
            "telephone_number": "262-654-6800",
            "fax_number": "262-657-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUNG",
        "first_name": "EDMUND",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Journey House International Center LLC
• Journey Within Counseling and Wellness Co.
• Vedrana Jovkovic, APNP
• Meghan Elizabeth Joyner, CCC-SLP
• Jaclyn Jozefiak, RDN, MS
• Junith M. Thompson, M.D., S.C.
• Rosalinda Jurvis, CNA
• Just Like Familt LLC
• Pollyanna Kabara, PA-C
• Faya Kacos-Shiu, LCSW

• General Practice Dentistry in Kenosha, WI
• Providers in Kenosha, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.