Healthcare Provider Details

I. General information

NPI: 1649357625
Provider Name (Legal Business Name): DAVID CHUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SHADOW LN # MS 7422
LAS VEGAS NV
89106-4124
US

IV. Provider business mailing address

9610 DEER PARK AVE
LAS VEGAS NV
89148-4200
US

V. Phone/Fax

Practice location:
  • Phone: 702-774-2538
  • Fax:
Mailing address:
  • Phone: 201-575-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-379C
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number044016
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: