Provider Demographics
NPI:1750018438
Name:CHUNG, CAITLIN H (DMD)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:H
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8087 SE HAYLOFT ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-2107
Mailing Address - Country:US
Mailing Address - Phone:503-936-1590
Mailing Address - Fax:
Practice Address - Street 1:15405 SW 116TH AVE STE 208
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97224-4101
Practice Address - Country:US
Practice Address - Phone:503-936-1590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11661122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist