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General NPI Number Information
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NPI Number | 1902970569
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Entity Type | Individual
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Provider Name | JEHYUN CHONG D.D.S
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Gender | Male
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 142-10B ROOSEVELT AVE SUITE #21
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City | FLUSHING
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State | NY
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Zip | 11354-6042
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Country | US
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Telephone | 718-358-5488
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Fax |
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Provider Business Mailing Address
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Address Line | 197-15 56TH AVE
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-1707
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Country | US
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Telephone |
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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 | 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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