Provider Demographics
NPI:1316507601
Name:CHUNG, DEBORAH HEYLIM (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:HEYLIM
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 UNION MILL RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124
Mailing Address - Country:US
Mailing Address - Phone:703-818-0007
Mailing Address - Fax:
Practice Address - Street 1:5730 UNION MILL RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:VA
Practice Address - Zip Code:20124
Practice Address - Country:US
Practice Address - Phone:703-818-0007
Practice Address - Fax:703-818-0010
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014164131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice