Active NPI
Soo Yeon Chung, DDS
- Dentist
- Buena Park, CA
National Provider Identifier
1235696071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DDS103159
- Practice address
- 5832 Beach Blvd Unit 202
Buena Park, CA 90621-5501 - Phone
- (714) 736-0100
- NPI assigned
- Feb 28, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0155 | MP | |
| Dentist | 122300000X | DDS103159 | CA | Primary |
Addresses
Primary practice location
5832 Beach Blvd Unit 202
Buena Park, CA 90621-5501
Mailing address
9543 Tivoli Cir
Cypress, CA 90630-3570
Phone (213) 999-2960
Other practice location 1
3530 Wilshire Blvd Ste 150
Los Angeles, CA 90010-2324
Phone (213) 739-2828
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS103159 | CA | MD | Dentist |
| 0155 | MP | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614211200000",
"number": "1235696071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9543 TIVOLI CIR",
"city": "CYPRESS",
"state": "CA",
"postal_code": "906303570",
"telephone_number": "213-999-2960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5832 BEACH BLVD UNIT 202",
"city": "BUENA PARK",
"state": "CA",
"postal_code": "906215501",
"telephone_number": "714-736-0100"
}
],
"practiceLocations": [
{
"address_1": "3530 Wilshire Blvd Ste 150",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900102324",
"country_code": "US",
"telephone_number": "213-739-2828",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHUNG",
"first_name": "SOO YEON",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-28",
"last_updated": "2021-02-25",
"certification_date": "2021-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MP",
"license": "0155",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "DDS103159",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buena Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.