Provider Demographics
NPI:1255644456
Name:ELEGINO, JUN UNGOS (DO)
Entity type:Individual
Prefix:DR
First Name:JUN
Middle Name:UNGOS
Last Name:ELEGINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:MR
Other - First Name:JUN
Other - Middle Name:UNGOS
Other - Last Name:ELEGINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:9411 N OAK TRFY STE LL1
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2262
Mailing Address - Country:US
Mailing Address - Phone:816-691-1655
Mailing Address - Fax:
Practice Address - Street 1:2750 CLAY EDWARDS DR STE 312
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3256
Practice Address - Country:US
Practice Address - Phone:816-453-4000
Practice Address - Fax:816-842-1486
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220494542086S0102X, 2086S0127X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN