Provider Demographics
NPI:1689739476
Name:CHUNG, JONG J (DDS)
Entity Type:Individual
Prefix:MR
First Name:JONG
Middle Name:J
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:13626 WARWICK BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-5566
Mailing Address - Country:US
Mailing Address - Phone:757-833-7217
Mailing Address - Fax:757-833-0134
Practice Address - Street 1:13626 WARWICK BLVD
Practice Address - Street 2:STE A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-5566
Practice Address - Country:US
Practice Address - Phone:757-833-7217
Practice Address - Fax:757-833-0134
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008234122300000X
VA8234122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7803249Medicaid
VA0006139Medicaid