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General NPI Number Information
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NPI Number | 1942747316
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Entity Type | Organization
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Legal Business Name | KWANG H. CHUNG,DMD, INC.
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 2703 MAHONING AVE
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City | YOUNGSTOWN
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State | OH
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Zip | 44509-2337
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Country | US
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Telephone | 330-793-5511
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Fax | 330-793-8740
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Provider Business Mailing Address
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Address Line | 2703 MAHONING AVE
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City | YOUNGSTOWN
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State | OH
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Zip | 44509-2337
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Country | US
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Telephone | 330-793-5511
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Fax | 330-793-8740
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KWANG H CHUNG
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Credential | DMD
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Telephone | 330-793-5511
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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 | 30.015087
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License Number State | OH
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