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General NPI Number Information
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NPI Number | 1487902136
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Entity Type | Individual
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Provider Name | HYEWON JAMIE CHUNG DDS, MMSC
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Gender | Female
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 1 EMBARCADERO CTR
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-3628
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Country | US
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Telephone | 415-680-5090
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Fax |
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Provider Business Mailing Address
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Address Line | 401 HARRISON ST APT 26C
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City | SAN FRANCISCO
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State | CA
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Zip | 94105-2791
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Country | US
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Telephone | 415-680-5090
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DL11707
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DDS64625
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License Number State | CA
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