Provider Demographics
NPI:1942400791
Name:CHUNG, JIYEON (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JIYEON
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 STONEGATE TRL
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2412
Mailing Address - Country:US
Mailing Address - Phone:917-903-2733
Mailing Address - Fax:
Practice Address - Street 1:22 WILCOX PL
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5516
Practice Address - Country:US
Practice Address - Phone:917-903-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0519451223P0300X
NJ023311001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics