Healthcare Provider Details

I. General information

NPI: 1548392160
Provider Name (Legal Business Name): YOONSANG CHUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

IV. Provider business mailing address

1905 CONVENIENCE PL SUITE B
CHAMPAIGN IL
61820-8926
US

V. Phone/Fax

Practice location:
  • Phone: 310-627-5850
  • Fax: 310-627-5855
Mailing address:
  • Phone: 217-356-7400
  • Fax: 217-356-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: