Active NPI
Jeannie Chung, DDS
- Periodontics
- Fremont, CA
National Provider Identifier
1265701528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 37538
- Practice address
- 39055 Hastings St
Suite 104
Fremont, CA 94538-1518 - Phone
- (510) 794-9954
- Fax
- (510) 794-1796
- NPI assigned
- Dec 15, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 37538 | CA | Primary |
Addresses
Primary practice location
39055 Hastings St
Suite 104
Fremont, CA 94538-1518
Mailing address
39055 Hastings St
Suite 104
Fremont, CA 94538-1518
Phone (510) 794-9954
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 |
|---|---|---|---|
| 37538 | CA | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jeannie Chung, DDS, Ms, Inc | Periodontics | 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.
-
- Periodontics
- Fremont, CA
- NPI 1457404592
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323907200000",
"number": "1265701528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39055 HASTINGS ST",
"address_2": "SUITE 104",
"city": "FREMONT",
"state": "CA",
"postal_code": "945381518",
"telephone_number": "510-794-9954",
"fax_number": "510-794-1796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39055 HASTINGS ST",
"address_2": "SUITE 104",
"city": "FREMONT",
"state": "CA",
"postal_code": "945381518",
"telephone_number": "510-794-9954",
"fax_number": "510-794-1796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHUNG",
"first_name": "JEANNIE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-15",
"last_updated": "2011-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "37538",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.