MEDICARE: JONG HOON CHUNG D.D.S.

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	36531	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801960067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONG HOON CHUNG D.D.S.

Provider Business Mailing Address
First Line	:	2110 E CESAR E CHAVEZ AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1823
Country	:	US
Telephone Number	:	323-268-8308
Fax Number	:	323-268-5672

Provider Business Practice Location Address
First Line	:	2110 E CESAR E CHAVEZ AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1823
Country	:	US
Telephone Number	:	323-268-8308
Fax Number	:	323-268-5672

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	03/11/2013

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