Provider Demographics
NPI:1295716322
Name:CHUNG, WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3459 5TH AVE
Mailing Address - Street 2:202SOUTH
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3236
Mailing Address - Country:US
Mailing Address - Phone:412-648-6080
Mailing Address - Fax:412-648-6505
Practice Address - Street 1:3459 5TH AVE
Practice Address - Street 2:202SOUTH
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3236
Practice Address - Country:US
Practice Address - Phone:412-648-6080
Practice Address - Fax:412-648-6505
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029690L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1947519Medicaid
PA1947519Medicaid