Provider Demographics
NPI:1598904385
Name:WOOJAE CHONG DMD PC
Entity Type:Organization
Organization Name:WOOJAE CHONG DMD PC
Other - Org Name:WOOJAE CHONG DMD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WOOJAE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-957-6411
Mailing Address - Street 1:401 COMMERCE DR STE 108
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2724
Mailing Address - Country:US
Mailing Address - Phone:215-646-6188
Mailing Address - Fax:
Practice Address - Street 1:24 S 14TH ST
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1147
Practice Address - Country:US
Practice Address - Phone:503-957-6411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOOJAE CHONG DMD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0365521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty