Healthcare Provider Details

I. General information

NPI: 1699237149
Provider Name (Legal Business Name): JOSEPH T HUNG DMD, MMSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/10/2022
Certification Date: 04/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 61ST ST STE 15N
NEW YORK NY
10065-8183
US

IV. Provider business mailing address

408 8TH AVE APT 10A
NEW YORK NY
10001-1816
US

V. Phone/Fax

Practice location:
  • Phone: 212-265-3577
  • Fax: 917-591-8881
Mailing address:
  • Phone: 917-645-2182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number048896
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: