Healthcare Provider Details

I. General information

NPI: 1174141808
Provider Name (Legal Business Name): HAEIM CHUNG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E ALLEGHENY AVE STE 201
PHILADELPHIA PA
19134-4427
US

IV. Provider business mailing address

2200 BENJAMIN FRANKLIN PKWY APT N1002
PHILADELPHIA PA
19130-3708
US

V. Phone/Fax

Practice location:
  • Phone: 215-743-3700
  • Fax:
Mailing address:
  • Phone: 717-798-7697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS042797
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: