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General NPI Number Information
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NPI Number | 1346306396
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Entity Type | Individual
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Provider Name | JAE YON CHUNG D.M.D
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Gender | Male
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 10/20/2008
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Provider Practice Location Address
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Address Line | 1570 S WESTERN AVE #201
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City | LOS ANGELES
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State | CA
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Zip | 90006-5829
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Country | US
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Telephone | 323-733-4567
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Fax |
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Provider Business Mailing Address
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Address Line | 386 S. BURNSIDE AVE #4-H
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City | LOS ANGELES
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State | CA
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Zip | 92844-1451
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Country | US
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Telephone | 310-346-2148
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 54473
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License Number State | CA
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