Provider Demographics
NPI:1245576321
Name:JAE YON CHUNG DENTAL INC
Entity Type:Organization
Organization Name:JAE YON CHUNG DENTAL INC
Other - Org Name:WHITE PLUS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:323-466-4567
Mailing Address - Street 1:1075 N WESTERN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2307
Mailing Address - Country:US
Mailing Address - Phone:323-466-4567
Mailing Address - Fax:323-733-0150
Practice Address - Street 1:1075 N WESTERN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2307
Practice Address - Country:US
Practice Address - Phone:323-466-4567
Practice Address - Fax:323-733-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty