MEDICARE: KWANG H. CHUNG,DMD, INC.

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	30.015087	OH

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	:	1942747316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KWANG H. CHUNG,DMD, INC.

Provider Business Mailing Address
First Line	:	2703 MAHONING AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44509-2337
Country	:	US
Telephone Number	:	330-793-5511
Fax Number	:	330-793-8740

Provider Business Practice Location Address
First Line	:	2703 MAHONING AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44509-2337
Country	:	US
Telephone Number	:	330-793-5511
Fax Number	:	330-793-8740

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KWANG H CHUNG
Credential	:	DMD
Telephone Number	:	330-793-5511

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/24/2017

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