Provider Demographics
NPI:1710003413
Name:CHUNG, MIN (PAUL) M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIN (PAUL)
Middle Name:M
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:M
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:41-25 KISSENA BLVD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-353-2312
Mailing Address - Fax:718-321-7120
Practice Address - Street 1:4125 KISSENA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3150
Practice Address - Country:US
Practice Address - Phone:718-353-2312
Practice Address - Fax:718-321-7120
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0428121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice