Active NPI
Chang Woo Jung, DMD
- Prosthodontics
- Ft Gordon, GA
National Provider Identifier
1245719780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 019.031649
- Practice address
- BLDG 38801 Academic Dr
Suite B&C
Ft Gordon, GA 30905-5645 - Phone
- (706) 787-7050
- NPI assigned
- Aug 7, 2018
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 019.031649 | IL | Primary |
Addresses
Primary practice location
BLDG 38801 Academic Dr
Suite B&C
Ft Gordon, GA 30905-5645
Mailing address
320 East Hospital Road
Fort Gordon, GA 30905
Phone (706) 787-5102
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 |
|---|---|---|---|
| 019.031649 | IL | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Martin Army Community Hospital | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Military/U.S. Coast Guard Outpatient Clinic/Center
- Fort Benning, GA
- NPI 1174726640
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689811200000",
"number": "1245719780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 EAST HOSPITAL ROAD",
"city": "FORT GORDON",
"state": "GA",
"postal_code": "30905",
"telephone_number": "706-787-5102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BLDG 38801 ACADEMIC DR",
"address_2": "SUITE B&C",
"city": "FT GORDON",
"state": "GA",
"postal_code": "309055645",
"telephone_number": "706-787-7050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUNG",
"first_name": "CHANG",
"middle_name": "WOO",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-07",
"last_updated": "2023-07-20",
"certification_date": "2023-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "IL",
"license": "019.031649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft Gordon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.