MEDICARE: DR. BRETT MYUNGSOO CHUNG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	53494	CA
2	1223G0001X	General Practice Dentistry	019025437	IL

General Provider Information

NPI Number	:	1124249990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT MYUNGSOO CHUNG DDS

Provider Business Mailing Address
First Line	:	4175 S. ALAMO AVE
Second Line	:
City	:	DAVIS-MONTHAN AFB
State	:	AZ
Zip	:	85707
Country	:	US
Telephone Number	:	520-228-2792
Fax Number	:

Provider Business Practice Location Address
First Line	:	4175 S. ALAMO AVE
Second Line	:
City	:	DAVIS-MONTHAN AFB
State	:	AZ
Zip	:	85707-4405
Country	:	US
Telephone Number	:	520-228-2792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	11/02/2022

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