Healthcare Provider Details

I. General information

NPI: 1033507181
Provider Name (Legal Business Name): JENNY CHUNG D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 HEMPSTEAD TPKE SUITE 202
EAST MEADOW NY
11554
US

IV. Provider business mailing address

1900 HEMPSTEAD TPKE SUITE 202
EAST MEADOW NY
11554
US

V. Phone/Fax

Practice location:
  • Phone: 516-794-9211
  • Fax:
Mailing address:
  • Phone: 516-794-9211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number056881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: