Healthcare Provider Details

I. General information

NPI: 1164080859
Provider Name (Legal Business Name): JONG UK CHUNG DDS, MS, MMSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 W MOUNT PLEASANT AVE
LIVINGSTON NJ
07039-1720
US

IV. Provider business mailing address

471 W MOUNT PLEASANT AVE
LIVINGSTON NJ
07039-1720
US

V. Phone/Fax

Practice location:
  • Phone: 973-840-7355
  • Fax:
Mailing address:
  • Phone: 973-840-7355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN1858283
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number063180
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number13813
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI03061100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: