Healthcare Provider Details

I. General information

NPI: 1679141139
Provider Name (Legal Business Name): DONG YOUNG CHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 STATE ST STE 104
HACKENSACK NJ
07601-5521
US

IV. Provider business mailing address

214 STATE ST # 531
HACKENSACK NJ
07601-5500
US

V. Phone/Fax

Practice location:
  • Phone: 201-268-7154
  • Fax:
Mailing address:
  • Phone: 917-743-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02796000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: