Active NPI
Won Jun Jung, D.D.S
- General Practice Dentistry
- Fort Worth, TX
National Provider Identifier
1912285420
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 28626
- Practice address
- 4200 South Fwy
Suite 805
Fort Worth, TX 76115-1400 - Phone
- (817) 924-4220
- NPI assigned
- Aug 1, 2011
- Last updated
- Oct 13, 2014
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 28626 | TX | Primary |
Addresses
Primary practice location
4200 South Fwy
Suite 805
Fort Worth, TX 76115-1400
Mailing address
4200 South Fwy
Suite 805
Fort Worth, TX 76115-1400
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28626 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brident Dental Associates PC | Past | Accepting new patients | |
| South Texas Dental Associates, LP | General Practice | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Dentist
- Fort Worth, TX
- NPI 1467926337
-
- General Practice Dentistry
- Fort Worth, TX
- NPI 1952742876
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1312156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413158400000",
"number": "1912285420",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4200 SOUTH FWY",
"address_2": "SUITE 805",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761151400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 SOUTH FWY",
"address_2": "SUITE 805",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761151400",
"telephone_number": "817-924-4220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUNG",
"first_name": "WON JUN",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-01",
"last_updated": "2014-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "28626",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.