Provider Demographics
NPI:1124140645
Name:CHUNG, HAESUNG (DDS)
Entity type:Individual
Prefix:
First Name:HAESUNG
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 1:1431 WESLEYS RUN
Mailing Address - Street 2:
Mailing Address - City:GLADWYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19035-1049
Mailing Address - Country:US
Mailing Address - Phone:610-613-9178
Mailing Address - Fax:
Practice Address - Street 1:219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TRAPPE
Practice Address - State:PA
Practice Address - Zip Code:19426-2000
Practice Address - Country:US
Practice Address - Phone:610-489-8331
Practice Address - Fax:610-489-1563
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0368501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice