Provider Demographics
NPI:1487902136
Name:CHUNG, HYEWON JAMIE (DDS, MMSC)
Entity type:Individual
Prefix:DR
First Name:HYEWON
Middle Name:JAMIE
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DDS, MMSC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:HYEWON
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:401 HARRISON ST APT 26C
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-2791
Mailing Address - Country:US
Mailing Address - Phone:415-680-5090
Mailing Address - Fax:
Practice Address - Street 1:1 EMBARCADERO CTR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3628
Practice Address - Country:US
Practice Address - Phone:415-680-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL117071223P0300X
CADDS646251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics