Provider Demographics
NPI:1952622433
Name:CHUNG, JUN H (DMD)
Entity Type:Individual
Prefix:
First Name:JUN
Middle Name:H
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19440 GOLF VISTA PLAZA
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176
Mailing Address - Country:US
Mailing Address - Phone:703-858-5990
Mailing Address - Fax:703-858-5991
Practice Address - Street 1:19440 GOLF VISTA PLAZA
Practice Address - Street 2:SUITE 250
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-858-5990
Practice Address - Fax:703-858-5991
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0383281223G0001X
VA04014137401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice