Active NPI
Mark Jung
- Periodontics
- Fargo, ND
National Provider Identifier
1619027117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 1874
- Practice address
- 3533 25TH St S
Fargo, ND 58104-5900 - Phone
- (701) 234-0333
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 1874 | ND | Primary |
Addresses
Primary practice location
3533 25TH St S
Fargo, ND 58104-5900
Mailing address
125 49TH Ave E
West Fargo, ND 58078-8221
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1874 | ND | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619027117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 49TH AVE E",
"city": "WEST FARGO",
"state": "ND",
"postal_code": "580788221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3533 25TH ST S",
"city": "FARGO",
"state": "ND",
"postal_code": "581045900",
"telephone_number": "701-234-0333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUNG",
"first_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "ND",
"license": "1874",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.