Individual provider Active NPI

Sanghyun Ju, DC

  • Chiropractor
  • Raleigh, NC
National Provider Identifier
1366532392
Registry record updated Sep 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3228 Issued in NC
Practice address
10208 Cerny St
Suite 205
Raleigh, NC 27617-7884
Phone
(919) 405-2002
Fax
(919) 405-2005
NPI assigned
Oct 13, 2006
Last updated
Sep 29, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3228 NC Primary

Addresses

Primary practice location

10208 Cerny St
Suite 205
Raleigh, NC 27617-7884

Mailing address

10208 Cerny St
Suite 205
Raleigh, NC 27617-7884
Phone (919) 405-2002

Other identifiers 2

IdentifierTypeStateIssuer
8908703MedicaidNC
085VGOtherNCCNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060321000201 NC Practitioner - Chiropractic 3476560186 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3228NCMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Ju Chiropractic Wellness Center, P.a. Chiropractor CurrentSince Sep 24, 2007 Accepting new patients

Locations

1000 Park Forty Plz
Ste 200
Durham, NC 27713
Phone (919) 405-2002

5314 NC Highway 55
Ste 105
Durham, NC 27713

10208 Cerny St
Ste 205
Raleigh, NC 27617
Phone (919) 402-7551

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317254400000",
    "number": "1366532392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10208 CERNY ST",
            "address_2": "SUITE 205",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276177884",
            "telephone_number": "919-405-2002",
            "fax_number": "919-405-2005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10208 CERNY ST",
            "address_2": "SUITE 205",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276177884",
            "telephone_number": "919-405-2002",
            "fax_number": "919-405-2005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JU",
        "first_name": "SANGHYUN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2011-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8908703",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CNC",
            "identifier": "085VG",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.