Provider Demographics
NPI:1174638795
Name:CHUNG, BILLY DAI-SUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:DAI-SUNG
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:D
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1107 MEMORIAL DR
Mailing Address - Street 2:STE 101
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8662
Mailing Address - Country:US
Mailing Address - Phone:706-277-9393
Mailing Address - Fax:706-277-9688
Practice Address - Street 1:1107 MEMORIAL DR
Practice Address - Street 2:STE 101
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8662
Practice Address - Country:US
Practice Address - Phone:706-277-9393
Practice Address - Fax:706-277-9688
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0114331223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BC4113255OtherDEA
59922Medicare UPIN
19NCRSNMedicare ID - Type Unspecified