Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 30749 | TX |
Y | 208200000X | Surgeon | Q6332 | TX |
Y | 208600000X | Surgeon | Q6332 | TX |
NPI | 1093978710 |
---|---|
Provider Name | Dr. Calvin G Jung |
First Address | Houston, TX 77098-4747 |
Second Address | Houston, TX 77098-4747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 10/10/2016 |