Individual
MR. TIMOTHY T K JUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PHD
Contact information
Practice address
3975 JACKSON STREET, SUITE 202, RIVERSIDE, CA 92503-3947
(951) 352-7920
(951) 352-7908
Mailing address
3975 JACKSON STREET, SUITE 202, RIVERSIDE, CA 92503-3947
(951) 352-7920
(951) 352-7908
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
G52096
CA
207Y00000X
Otolaryngology Physician
Primary
G52096
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G520960
MEDICARE RENDERING ID
CA
05
—
00G520961
—
CA
05
—
OOG520960
—
CA
01
—
ZZZ32000Z
MEDICARE GROUP ID
CA
Enumeration date
04/03/2006
Last updated
01/14/2010
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