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General NPI Number Information
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NPI Number | 1396364006
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Entity Type | Individual
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Provider Name | NICHOLAS CHUNG DMD
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Gender | Male
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 400 W MORSE BLVD STE 102
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City | WINTER PARK
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State | FL
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Zip | 32789-4259
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Country | US
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Telephone | 407-644-4463
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 MORGAN STANLEY AVE UNIT 516
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City | WINTER PARK
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State | FL
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Zip | 32789-1977
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Country | US
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Telephone | 407-865-2080
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN24929
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License Number State | FL
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