Cheolwon Chung, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

34162 Issued in TX

Practice address

2631 Faudree Rd Ste B
Odessa, TX 79765-8530

Phone

(432) 339-4444

NPI assigned

Jun 9, 2018

Last updated

Jun 9, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528502400000",
    "number": "1235622762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 ALLENDALE RD APT 1423",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770175480",
            "telephone_number": "832-638-9428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2631 FAUDREE RD STE B",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797658530",
            "telephone_number": "432-339-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "CHEOLWON",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-09",
        "last_updated": "2018-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "34162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George Choumarov Sr., M.D.
• Rachel Christian, M.S., OTR/L
• Rebecca Marie Christian, MA, LPC-S, LCDC
• Tracy Onyinye Chukwu, M.D
• Obinna Victor Chukwuma, MBBS
• Cibolo Park Healthcare LLC (Parks Assisted Living Center)
• City of Odessa (City of Odessa Ambulance Service)
• Clark Chiropractic Clinic
• Roger Dale Clark, HIS
• Virginia Gayle Clark, LPC

• General Practice Dentistry in Odessa, TX
• Providers in Odessa, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2018; 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.

Verify at the official NPI Registry.