Provider Demographics
NPI:1518199355
Name:CHUNG, SE-A (DMD)
Entity Type:Individual
Prefix:DR
First Name:SE-A
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ROUTE 17
Mailing Address - Street 2:#625
Mailing Address - City:TUXEDO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:10987-4410
Mailing Address - Country:US
Mailing Address - Phone:845-351-5158
Mailing Address - Fax:
Practice Address - Street 1:220 ROUTE 17
Practice Address - Street 2:#625
Practice Address - City:TUXEDO PARK
Practice Address - State:NY
Practice Address - Zip Code:10987-4410
Practice Address - Country:US
Practice Address - Phone:845-351-5158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0517401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice