Provider Demographics
NPI:1164080859
Name:CHUNG, JONG UK (DDS, MS, MMSC)
Entity Type:Individual
Prefix:DR
First Name:JONG UK
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS, MS, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2169
Mailing Address - Country:US
Mailing Address - Phone:914-967-2277
Mailing Address - Fax:
Practice Address - Street 1:262 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2169
Practice Address - Country:US
Practice Address - Phone:914-967-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0631801223X0400X
CT138131223X0400X
MADN1858283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics