Provider Demographics
NPI:1972761773
Name:CHONG, WOOJAE (DMD)
Entity type:Individual
Prefix:
First Name:WOOJAE
Middle Name:
Last Name:CHONG
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 1:3301 PERIMETER LOFTS CIR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1725
Mailing Address - Country:US
Mailing Address - Phone:762-233-7896
Mailing Address - Fax:
Practice Address - Street 1:3301 PERIMETER LOFTS CIR
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30346-1725
Practice Address - Country:US
Practice Address - Phone:762-233-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0365521223P0300X
GADN0146251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN014625OtherGEORGIA BOARD OF DENTISTRY
PADS036552OtherDENTAL LICENSE NUMBER