So Yeon Chung
Individual provider Active NPI General Practice Dentistry · Azle, TX
NPI 1598043549 · NPPES record last updated Oct 14, 2019
Key facts
- NPI
- 1598043549
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 29645 (TX)
- Practice address
- 112 Industrial Ave
Azle, TX 76020 - Phone
- (817) 270-3700
- NPI assigned
- Jul 25, 2011
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29645 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shiny Studio PLLC | Current |
Accepting new patients | |
| Forever Teeth P.L.L.C. | General Practice | Past |
Accepting new patients |
Locations
112 Industrial Ave
Azle, TX 76020
Phone (817) 270-3700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 29645 | TX | Yes |
Addresses
Primary practice location
112 Industrial Ave
Azle, TX 76020
Mailing address
708 Glen Abbey Dr
Southlake, TX 76092-1378
Phone (347) 899-5601
Other providers in Azle, TX
- Angela Cavender
- Certified Dementia Specialist, LLC
- Roney Chaluparambil Marcos
- William Melvin Chambers Jr.
- Cynthia Dianne Chamness
- City of Azle
- Brittany Collins
- Complete Emergency Care Azle LLC
- Jeremy Corbin
- Benjamin Oscar Corrales
All providers in Azle, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.