Provider Demographics
NPI:1881438570
Name:CHUNG, RAYMOND TIM (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:TIM
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 1:20875 FM 1485 RD
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-7471
Mailing Address - Country:US
Mailing Address - Phone:281-689-5266
Mailing Address - Fax:
Practice Address - Street 1:20875 FM 1485 RD
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-7471
Practice Address - Country:US
Practice Address - Phone:281-689-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist