Provider Demographics
NPI:1821243551
Name:CHUNG, JOO SUNG
Entity Type:Individual
Prefix:DR
First Name:JOO SUNG
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 W OLYMPIC BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2368
Mailing Address - Country:US
Mailing Address - Phone:323-766-1004
Mailing Address - Fax:323-731-2875
Practice Address - Street 1:3250 W OLYMPIC BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2368
Practice Address - Country:US
Practice Address - Phone:323-766-1004
Practice Address - Fax:323-731-2875
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA454441223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics