Justin David Chung, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12244 Issued in CT

Practice address

483 Middle Tpke W Ste 209
Manchester, CT 06040-3864

Phone

(860) 649-3129

NPI assigned

Jun 20, 2017

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1497275697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "483 MIDDLE TPKE W STE 209",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403864",
            "telephone_number": "860-649-3129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "483 MIDDLE TPKE W STE 209",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403864",
            "telephone_number": "860-649-3129"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 1st Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100297404",
            "country_code": "US",
            "telephone_number": "212-423-8977",
            "fax_number": "212-423-8495",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "JUSTIN",
        "middle_name": "DAVID",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-20",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "12244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chin Up Clinical Services LLC
• Chiropractic Family Health Center of Manchester,LLC
• Tyler M Chita, LMSW
• Ghania N Chohan, DDS
• Michael Christian, D.M.D.
• Steven P. Chung, DMD
• Christina Chykirda, LPC
• Corrie J Cirelli
• Imelda Angelica Perez Cirilo, M.D.
• Ibrahima Cisse

• General Practice Dentistry in Manchester, CT
• Providers in Manchester, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.

Verify at the official NPI Registry.