Healthcare Provider Details

I. General information

NPI: 1508545708
Provider Name (Legal Business Name): HYOSANG CHEON D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date: 05/16/2024
Reactivation Date: 08/21/2025

III. Provider practice location address

310 WASHINGTON AVE
NORTH HAVEN CT
06473-1315
US

IV. Provider business mailing address

201 MUNSON ST APT 470
NEW HAVEN CT
06511-0649
US

V. Phone/Fax

Practice location:
  • Phone: 860-609-3558
  • Fax:
Mailing address:
  • Phone: 718-710-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14450
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: