MEDICARE: DR. JENNY CHEN 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	122300000X	Dentist	30497	CA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	9911	CA

General Provider Information

NPI Number	:	1306859160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNY CHEN CHUNG DDS

Provider Business Mailing Address
First Line	:	1728 S SAN GABRIEL BLVD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776
Country	:	US
Telephone Number	:	626-572-0087
Fax Number	:	626-572-0888

Provider Business Practice Location Address
First Line	:	1728 S SAN GABRIEL BLVD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776
Country	:	US
Telephone Number	:	626-572-0087
Fax Number	:	626-572-0888

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	09/11/2025

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