Active NPI
Bong Jung, MD
- Neurology Physician
- Saginaw, MI
National Provider Identifier
1619953197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- BJ040138
- Practice address
- 4705 Towne Centre Rd
Suite 102
Saginaw, MI 48604-2818 - Phone
- (989) 791-4718
- Fax
- (989) 791-4882
- NPI assigned
- Dec 16, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | BJ040138 | MI | Primary |
Addresses
Primary practice location
4705 Towne Centre Rd
Suite 102
Saginaw, MI 48604-2818
Mailing address
4705 Towne Centre Rd
Suite 102
Saginaw, MI 48604-2818
Phone (989) 791-4718
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104020 | Other | GREAT LAKES HEALTH PLAN | |
| 130026263 | Other | TRAVELERS MEDICARE | |
| 1748983 | Medicaid | MI | |
| 0730194 | Other | BLUE CROSS | |
| 1307309121 | Other | MI | HEALTH PLUS |
| 1307309121 | Other | BLUE CARE NETWORK |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BJ040138 | MI | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375747200000",
"number": "1619953197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4705 TOWNE CENTRE RD",
"address_2": "SUITE 102",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486042818",
"telephone_number": "989-791-4718",
"fax_number": "989-791-4882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4705 TOWNE CENTRE RD",
"address_2": "SUITE 102",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486042818",
"telephone_number": "989-791-4718",
"fax_number": "989-791-4882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUNG",
"first_name": "BONG",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-16",
"last_updated": "2013-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MI",
"license": "BJ040138",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT LAKES HEALTH PLAN",
"identifier": "104020",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRAVELERS MEDICARE",
"identifier": "130026263",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1748983",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "0730194",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PLUS",
"identifier": "1307309121",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "1307309121",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Saginaw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.