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General NPI Number Information
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NPI Number | 1518038090
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Entity Type | Organization
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Legal Business Name | TINA S. CHUNG, DMD, MS, LLC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1005 CLIFTON AVENUE
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City | CLIFTON
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State | NJ
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Zip | 07013
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Country | US
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Telephone | 973-773-2933
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Fax | 973-773-5723
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Provider Business Mailing Address
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Address Line | 1005 CLIFTON AVENUE
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City | CLIFTON
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State | NJ
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Zip | 07013
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Country | US
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Telephone | 973-773-2933
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Fax | 973-773-5723
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Authorized Official
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Title or Position | MANAGER OF LLC
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Name | DR. TINA S. CHUNG
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Credential | D.M.D.
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Telephone | 973-773-2933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DI19816
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License Number State | NJ
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