Active NPI
Jay H Chung, DDS
- Dentist
- Potomac, MD
National Provider Identifier
1194933325
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10761
- Practice address
- 10 Brent CT
Potomac, MD 20854-1780 - Phone
- (301) 299-4780
- NPI assigned
- May 20, 2007
- Last updated
- Feb 29, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10761 | MD | Primary |
Addresses
Primary practice location
10 Brent CT
Potomac, MD 20854-1780
Mailing address
10 Chestnut Street
130
Gaithersburg, MD 20877
Phone (301) 977-8100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160419002213 | MD | Order and Referring Only - Oral Surgery | 5991003212 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10761 | MD | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456704000000",
"number": "1194933325",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 CHESTNUT STREET",
"address_2": "130",
"city": "GAITHERSBURG",
"state": "MD",
"postal_code": "20877",
"telephone_number": "301-977-8100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 BRENT CT",
"city": "POTOMAC",
"state": "MD",
"postal_code": "208541780",
"telephone_number": "301-299-4780"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHUNG",
"first_name": "JAY",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-20",
"last_updated": "2016-02-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "10761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Potomac, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.