Provider Demographics
NPI:1457579419
Name:CHUNG, KENNETH L (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 SE CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6618
Mailing Address - Country:US
Mailing Address - Phone:503-653-8320
Mailing Address - Fax:503-774-3596
Practice Address - Street 1:3245 SE CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6618
Practice Address - Country:US
Practice Address - Phone:503-653-8320
Practice Address - Fax:503-774-3596
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD59471223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health