=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598904385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOOJAE CHONG DMD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2009
-----------------------------------------------------
Last Update Date | 02/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 S 14TH ST
-----------------------------------------------------
City | QUAKERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18951-1147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-957-6411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 COMMERCE DR STE 108
-----------------------------------------------------
City | FORT WASHINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19034-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-646-6188
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WOOJAE CHONG
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 503-957-6411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | DS036552
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------