MEDICARE: DR. DAVID CHUNG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	S3-379C	NV
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	044016	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649357625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CHUNG DDS

Provider Business Mailing Address
First Line	:	9610 DEER PARK AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4200
Country	:	US
Telephone Number	:	201-575-1757
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 SHADOW LN # MS 7422
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4124
Country	:	US
Telephone Number	:	702-774-2538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	11/06/2024

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Directions to “ DR. DAVID CHUNG DDS” Practice Location

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