Provider Demographics
NPI:1518038090
Name:TINA S. CHUNG, DMD, MS, LLC
Entity Type:Organization
Organization Name:TINA S. CHUNG, DMD, MS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-773-2933
Mailing Address - Street 1:1005 CLIFTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-773-2933
Mailing Address - Fax:973-773-5723
Practice Address - Street 1:1005 CLIFTON AVENUE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-773-2933
Practice Address - Fax:973-773-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI198161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty