Healthcare Provider Details

I. General information

NPI: 1295716322
Provider Name (Legal Business Name): WILLIAM CHUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 W MICHIGAN ST
INDIANAPOLIS IN
46202-5211
US

IV. Provider business mailing address

1121 W MICHIGAN ST
INDIANAPOLIS IN
46202-5211
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-7433
  • Fax: 317-274-2603
Mailing address:
  • Phone: 317-274-7433
  • Fax: 317-274-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12013940A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: