Provider Demographics
NPI:1811109606
Name:CHUNG, CHRISTOPHER HASAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:HASAN
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 1:1512 PALISADE AVE
Mailing Address - Street 2:APT #19L
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5308
Mailing Address - Country:US
Mailing Address - Phone:201-923-1144
Mailing Address - Fax:
Practice Address - Street 1:381 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:201-242-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ210691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics