Provider Demographics
NPI:1780772129
Name:CHUNG, CHIH CHANG (DDS)
Entity type:Individual
Prefix:
First Name:CHIH CHANG
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 1:13527 38TH AVE
Mailing Address - Street 2:SUITE 368
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4406
Mailing Address - Country:US
Mailing Address - Phone:718-961-6668
Mailing Address - Fax:718-961-6699
Practice Address - Street 1:13527 38TH AVE
Practice Address - Street 2:SUITE 368
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4406
Practice Address - Country:US
Practice Address - Phone:718-961-6668
Practice Address - Fax:718-961-6699
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY474331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice