Provider Demographics
NPI:1346306396
Name:CHUNG, JAE YON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:YON
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 S. BURNSIDE AVE
Mailing Address - Street 2:#4-H
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1451
Mailing Address - Country:US
Mailing Address - Phone:310-346-2148
Mailing Address - Fax:
Practice Address - Street 1:1570 S WESTERN AVE
Practice Address - Street 2:#201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5829
Practice Address - Country:US
Practice Address - Phone:323-733-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA544731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice