Provider Demographics
NPI:1609369891
Name:CHUNG, YOO JIN (DMD)
Entity type:Individual
Prefix:
First Name:YOO JIN
Middle Name:
Last Name:CHUNG
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10979 LOST LAKE DR APT 2-301
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-3165
Mailing Address - Country:US
Mailing Address - Phone:504-338-0524
Mailing Address - Fax:
Practice Address - Street 1:404 E CENTRAL BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1908
Practice Address - Country:US
Practice Address - Phone:407-440-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN258131223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice