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General NPI Number Information
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NPI Number | 1790180693
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Entity Type | Organization
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Legal Business Name | QUEENS ORAL AND FACIAL SURGERY
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 40-19 159TH ST. 1 FL.
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City | FLUSHING
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State | NY
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Zip | 11358
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Country | US
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Telephone | 718-358-5488
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Fax | 917-285-2676
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Provider Business Mailing Address
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Address Line | 40-19 159TH ST. 1 FL.
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City | FLUSHING
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State | NY
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Zip | 11358
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Country | US
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Telephone | 718-358-5488
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Fax | 917-285-2676
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JEHYUN CHONG
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Credential | D.D.S
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Telephone | 718-358-5488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 051035
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 051829
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 051051
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License Number State | NY
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