Provider Demographics
NPI:1134301583
Name:CHOUNG, JAE EUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:EUN
Last Name:CHOUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 BACON HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-3501
Mailing Address - Country:US
Mailing Address - Phone:917-656-5733
Mailing Address - Fax:
Practice Address - Street 1:61 BACON HILL RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-3501
Practice Address - Country:US
Practice Address - Phone:917-656-5733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN40221223G0001X
NY052288-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice