Provider Demographics
NPI:1134975741
Name:NG, CHUNG (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CHUNG
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:WILSON
Other - Middle Name:
Other - Last Name:NG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2345 MORAGA ST UPPR UNIT
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4205
Mailing Address - Country:US
Mailing Address - Phone:415-830-2732
Mailing Address - Fax:
Practice Address - Street 1:2220 MOUNTAIN BLVD STE 204
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2905
Practice Address - Country:US
Practice Address - Phone:510-482-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1056171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics