MEDICARE: CAITLIN H CHUNG DMD

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	122300000X	Dentist	D11661	OR

General Provider Information

NPI Number	:	1750018438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN H CHUNG DMD

Provider Business Mailing Address
First Line	:	8087 SE HAYLOFT ST
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97123-2107
Country	:	US
Telephone Number	:	503-936-1590
Fax Number	:

Provider Business Practice Location Address
First Line	:	15405 SW 116TH AVE STE 208
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97224-4101
Country	:	US
Telephone Number	:	503-936-1590
Fax Number	:

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

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	08/03/2022

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Directions to “ CAITLIN H CHUNG DMD” Practice Location

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