Provider Demographics
NPI:1558983270
Name:CHUNG, CHAN KWON
Entity type:Individual
Prefix:
First Name:CHAN KWON
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1379 MORRIS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3340
Mailing Address - Country:US
Mailing Address - Phone:609-676-5702
Mailing Address - Fax:
Practice Address - Street 1:1379 MORRIS AVE STE 1
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3340
Practice Address - Country:US
Practice Address - Phone:609-676-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI030660001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics