Provider Demographics
NPI:1881979672
Name:CHUNG, HO RYUN (DDS)
Entity type:Individual
Prefix:
First Name:HO
Middle Name:RYUN
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:PHILIP
Other - Middle Name:HORYUN
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:170 W MAIN ST
Mailing Address - Street 2:APT#205K
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2562
Mailing Address - Country:US
Mailing Address - Phone:714-334-5001
Mailing Address - Fax:
Practice Address - Street 1:170 W MAIN ST
Practice Address - Street 2:APT# 205K
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2562
Practice Address - Country:US
Practice Address - Phone:714-334-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010653122300000X, 1223G0001X
NY055859122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist