MEDICARE: NANCY DAY 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	1223P0221X	Pediatric Dentistry	22DI02287200	NJ

General Provider Information

NPI Number	:	1952514291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY DAY CHUNG D.D.S.

Provider Business Mailing Address
First Line	:	1625 ANDERSON AVE
Second Line	:	SUITE 304
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2748
Country	:	US
Telephone Number	:	201-224-2747
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 ANDERSON AVE
Second Line	:	SUITE 304
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2748
Country	:	US
Telephone Number	:	201-224-2747
Fax Number	:

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	09/16/2016

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