Provider Demographics
NPI:1467701599
Name:CHUNG, JUSTIN I (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:I
Last Name:CHUNG
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 1:2044 CENTER AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4930
Mailing Address - Country:US
Mailing Address - Phone:201-242-9700
Mailing Address - Fax:
Practice Address - Street 1:2044 CENTER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4930
Practice Address - Country:US
Practice Address - Phone:201-242-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055804-011223P0700X
NJ22DI02480100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics