Provider Demographics
NPI:1598968760
Name:CHUNG, YOUNG WOONG (DDS)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:WOONG
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 1:29151 WILLOWWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5403
Mailing Address - Country:US
Mailing Address - Phone:909-863-0966
Mailing Address - Fax:909-793-2960
Practice Address - Street 1:16 E FERN AVE STE E
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4000
Practice Address - Country:US
Practice Address - Phone:909-793-2969
Practice Address - Fax:909-793-2960
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA403451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice