1689739476 NPI number — MR. JONG J CHUNG DDS

Table of content: MR. JONG J CHUNG DDS (NPI 1689739476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689739476 NPI number — MR. JONG J CHUNG DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUNG
Provider First Name:
JONG
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHUNG
Provider Other First Name:
JOHN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689739476
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13626 WARWICK BLVD
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23602-5566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-833-7217
Provider Business Mailing Address Fax Number:
757-833-0134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13626 WARWICK BLVD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23602-5566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-833-7217
Provider Business Practice Location Address Fax Number:
757-833-0134
Provider Enumeration Date:
12/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  0401008234 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 8234 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7803249 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0006139 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".