Provider Demographics
NPI:1376693747
Name:HUNG, CHUNG Y (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHUNG
Middle Name:Y
Last Name:HUNG
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 1:573 VALLEY RD
Mailing Address - Street 2:4 A
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3511
Mailing Address - Country:US
Mailing Address - Phone:973-696-0170
Mailing Address - Fax:973-696-0170
Practice Address - Street 1:573 VALLEY RD
Practice Address - Street 2:4 A
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3511
Practice Address - Country:US
Practice Address - Phone:973-696-0170
Practice Address - Fax:973-696-0170
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 00113101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice