Provider Demographics
NPI:1568662146
Name:CHUNG, JAE WOO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:WOO
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 1:1395 E WARNER RD
Mailing Address - Street 2:STE. 105C
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3160
Mailing Address - Country:US
Mailing Address - Phone:480-558-0212
Mailing Address - Fax:480-558-0216
Practice Address - Street 1:1395 E WARNER RD
Practice Address - Street 2:STE. 105C
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3160
Practice Address - Country:US
Practice Address - Phone:480-558-0212
Practice Address - Fax:480-558-0216
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD73191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice