Provider Demographics
NPI:1023399755
Name:JUNG, HANUL (PTA, LAC)
Entity type:Individual
Prefix:
First Name:HANUL
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:PTA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14428 HOMECREST RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1820
Mailing Address - Country:US
Mailing Address - Phone:240-506-6549
Mailing Address - Fax:
Practice Address - Street 1:14428 HOMECREST RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1820
Practice Address - Country:US
Practice Address - Phone:240-506-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000988171100000X
VA2306603843225200000X
MDA3686225200000X
VA0019018448225700000X
MDU02656171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU02656OtherDHMH
MDA3686Medicaid