Provider Demographics
NPI:1053586339
Name:CHUNG, KYUNG MIN (DMD)
Entity type:Individual
Prefix:DR
First Name:KYUNG
Middle Name:MIN
Last Name:CHUNG
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 1:90 VANDENBERG DRIVE
Mailing Address - Street 2:
Mailing Address - City:HANSCOM AFB
Mailing Address - State:MA
Mailing Address - Zip Code:01731
Mailing Address - Country:US
Mailing Address - Phone:781-225-6324
Mailing Address - Fax:
Practice Address - Street 1:90 VANDENBERG DRIVE
Practice Address - Street 2:
Practice Address - City:HANSCOM AFB
Practice Address - State:MA
Practice Address - Zip Code:01731
Practice Address - Country:US
Practice Address - Phone:781-225-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice