EUNSU JUNG (NPI# 1770962375) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770962375 |
| Entity Type | Individual |
| Full Name | EUNSU JUNG |
| Practice Address |
1902 N Prospect Ave Ste 1 Champaign IL 61822-1411 |
| Mailing Address |
19049 Sawyer Ter Germantown MD 20874-6227 |
| Practice Telephone | 7034723989 |
| Mailing Telephone | 7034723989 |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2020-08-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
021003045 | IL | Dental Providers |
| Street Address |
1902 N PROSPECT AVE STE 1 |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61822-1411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285288035 | Sara Shekari | Dentist | 1902 N Prospect Ave Ste 1, Champaign, IL 61822-1411 | 2019-07-30 |
| 1548772114 | Philco Dental Group LLC - Champaign | Dentist | 1902 N Prospect Ave Ste 1, Champaign, IL 61822-1411 | 2017-11-03 |
| 1457871188 | Brandon Meckelberg | Dentist | 1902 N Prospect Ave Ste 1, Champaign, IL 61822-1411 | 2017-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083180830 | Osf Multi-specialty Group | Non-Pharmacy Dispensing Site | 2718 N Prospect Avenue, Champaign, IL 61822 | 2018-10-19 |
| 1487129730 | Siegfred T. Celis | Occupational Therapy Assistant | 1820 Oak Park Drive, Champaign, IL 61822 | 2018-10-12 |
| 1134633746 | Osf Healthcare System | Home Health | 1501 Interstate Dr Ste C, Champaign, IL 61822 | 2017-11-20 |
| 1386164200 | Carlo Sandico | Physical Therapist | 612 Corey Lane, Champagne, IL 61822 | 2017-06-21 |
| 1295270288 | Jennifer Lee Lugo | Registered Nurse | 3101 Fields South Dr., Champaign, IL 61822 | 2016-12-29 |
| 1902341209 | Jala Simmons | Behavioral Analyst | 4112 Fieldstone Rd, Suite B, Champaign, IL 61822 | 2016-12-22 |
| 1639552433 | Muhammad Ajmal | Internal Medicine | 1701 Curtis Road, Carle Clinic, Champaign, IL 61822 | 2015-06-30 |
| 1518363761 | Margaret A. Hallden | Hearing Instrument Specialist | 3354 Big Pine Trail #c, Audibel Hearing Aids, Champaign, IL 61822 | 2014-11-17 |
| 1801291638 | Kristen Karlsen | Pharmacist | 3114 Village Office Place, Champaign, IL 61822 | 2014-10-22 |
| 1649601543 | Jeff Chu | Optometrist | 507 W. Town Center Blvd, Champaign, IL 61822 | 2013-12-03 |
| Find all providers in zip 61822 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144423963 | Theron Waisath | Dentist | 3112 Village Office Pl, Champaign, IL 61822-7680 | 2007-06-08 |
| 1518025394 | Eugene Michael Ozment | Dentist | 3112 Village Office Place, Champaign, IL 61822 | 2006-12-05 |
| 1669540399 | Central Illinois Oral & Maxiofacial Surgery, PC | Dentist | 14 E Anthony Dr, Suite C, Champaign, IL 61820-2748 | 2006-12-01 |
| 1750397501 | Victor Escobar | Dentist | 2917 Crossing Ct Ste A, Champaign, IL 61822-6185 | 2006-08-01 |
| 1265946081 | Omfs Practice Inc. | Dentist | 2917 Crossing Ct Ste A, Champaign, IL 61822-6185 | 2017-12-01 |
| 1215196290 | Affiliates In Oral & Maxillofacial Surgery Ltd | Dentist | 3112 Village Office Pl, Champaign, IL 61822-7680 | 2008-06-05 |
| 1326053851 | Richard P. Bianco | Dentist | 101 W University Ave, Champaign, IL 61820-3909 | 2006-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255986576 | Othman Rezki | Dentist | 1900 W Polk St # 611, Chicago, IL 60612-3723 | 2019-08-04 |
| 1215410584 | David Peterson | Dentist | 1619 Brandywine Ln, Dixon, IL 61021-8757 | 2018-09-12 |
| 1952887374 | Winnebago Braces, LLC. | Dentist | 555 N Court St Ste 110, Rockford, IL 61103-6898 | 2018-07-18 |
| 1093232951 | Robert C. Bosack, Dds & Associates, Ltd | Dentist | 16011 108th Ave Ste A, Orland Park, IL 60467-8787 | 2017-08-23 |
| 1790146132 | Family Millennium Dentistry, Inc. | Dentist | 1342 W Randolph St, Chicago, IL 60607-1522 | 2016-03-13 |
| 1811374945 | Alexandria Hawkins | Dentist | 6050 Brynwood Dr Ste 102, Rockford, IL 61114-6579 | 2015-04-27 |
| 1043607872 | Alissa Nicole Pullos | Dentist | 105 E 1st St Ste 103, Hinsdale, IL 60521 | 2015-04-20 |
| 1538592654 | Matthew Seena Hamedani | Dentist | 3116 Oak Park Ave, Berwyn, IL 60402 | 2013-08-13 |
| 1578907689 | M Timothy Murphy | Dentist | 500 Davis St Ste 509, Evanston, IL 60201-4621 | 2013-04-18 |
| 1104260314 | Cameron James Walker | Dentist | 2160 S 1st Ave Rm 1814, Maywood, IL 60153-3328 | 2013-04-18 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on EUNSU JUNG.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.