Provider Demographics
NPI:1548392160
Name:CHUNG, YOONSANG (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOONSANG
Middle Name:
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 1:1905 CONVENIENCE PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-8926
Mailing Address - Country:US
Mailing Address - Phone:217-356-7400
Mailing Address - Fax:217-356-7405
Practice Address - Street 1:121 S LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3423
Practice Address - Country:US
Practice Address - Phone:310-627-5850
Practice Address - Fax:310-627-5855
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist