Provider Demographics
NPI:1942747316
Name:KWANG H. CHUNG,DMD, INC.
Entity Type:Organization
Organization Name:KWANG H. CHUNG,DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KWANG
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:330-793-5511
Mailing Address - Street 1:2703 MAHONING AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-2337
Mailing Address - Country:US
Mailing Address - Phone:330-793-5511
Mailing Address - Fax:330-793-8740
Practice Address - Street 1:2703 MAHONING AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-2337
Practice Address - Country:US
Practice Address - Phone:330-793-5511
Practice Address - Fax:330-793-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.015087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0329817Medicaid