Provider Demographics
NPI:1134653017
Name:CHUNG, JANETTE (DDS)
Entity type:Individual
Prefix:DR
First Name:JANETTE
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 BOYLSTON ST UNIT 922
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4461
Mailing Address - Country:US
Mailing Address - Phone:408-644-1584
Mailing Address - Fax:
Practice Address - Street 1:1286 KIFER RD STE 105
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-5326
Practice Address - Country:US
Practice Address - Phone:408-736-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1020901223G0001X
390200000X
MADN100006961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program