Provider Demographics
NPI:1801960067
Name:CHUNG, JONG HOON (DDS)
Entity type:Individual
Prefix:
First Name:JONG HOON
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1823
Mailing Address - Country:US
Mailing Address - Phone:323-268-8308
Mailing Address - Fax:323-268-5672
Practice Address - Street 1:2110 E CESAR E CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1823
Practice Address - Country:US
Practice Address - Phone:323-268-8308
Practice Address - Fax:323-268-5672
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB36531-01Medicaid