Healthcare Provider Details

I. General information

NPI: 1669452082
Provider Name (Legal Business Name): JINJONG CHUNG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAHC VILSECK UNIT 28083
APO AE
09112
DE

IV. Provider business mailing address

CMR 411 BOX 2027
APO AE
09112
DE

V. Phone/Fax

Practice location:
  • Phone: 499622833322
  • Fax:
Mailing address:
  • Phone: 499662416466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3580
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: