Provider Demographics
NPI:1356829162
Name:MIN, KYUNG CHEON (DDS)
Entity Type:Individual
Prefix:
First Name:KYUNG CHEON
Middle Name:
Last Name:MIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 EDEN WAY N APT 404
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3368
Mailing Address - Country:US
Mailing Address - Phone:248-971-3884
Mailing Address - Fax:
Practice Address - Street 1:1230 PROGRESSIVE DR STE 103
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0203
Practice Address - Country:US
Practice Address - Phone:757-436-1270
Practice Address - Fax:757-436-2973
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist