Wonsik Jung, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12013746A Issued in IN

Practice address

1547 Ohio Ave
Anderson, IN 46016-1917

Phone

(765) 641-7684

NPI assigned

Jul 14, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Dentist

Education

Howard University College of Dentistry, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

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.

• Aria Dental Care PC

  • Dentist
  • Overland Park, KS
  • NPI 1942977632

  IN

  Medicare reassignment
• Heart of Kansas Family Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Great Bend, KS
  • NPI 1184739443
  NPD (past)

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

{
    "created_epoch": "1563062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1487206041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1547 OHIO AVE",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460161917",
            "telephone_number": "765-641-7684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1547 OHIO AVE",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460161917",
            "telephone_number": "765-641-7684"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1121 Arlington Blvd",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "VA",
            "postal_code": "222093214",
            "country_code": "US",
            "telephone_number": "202-957-8401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1518 Main St",
            "address_purpose": "LOCATION",
            "city": "Elwood",
            "state": "IN",
            "postal_code": "460362021",
            "country_code": "US",
            "telephone_number": "765-641-7684",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JUNG",
        "first_name": "WONSIK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-14",
        "last_updated": "2024-05-30",
        "certification_date": "2022-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS042460",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "61731",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12013746A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Philadelphia",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Philadelphia",
            "address_1": "2459 Aramingo Ave",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191253731",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Dentist in Anderson, IN
• Providers in Anderson, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.