So Yeon Chung

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

29645 Issued in TX

Practice address

112 Industrial Ave
Azle, TX 76020

Phone

(817) 270-3700

NPI assigned

Jul 25, 2011

Last updated

Oct 14, 2019By the provider in NPPES

Sex

Female

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

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shiny Studio PLLC

  • Dental Clinic/Center
  • Azle, TX
  • NPI 1073155784
  NPD Authorized official
• Forever Teeth P.L.L.C.

  • General Practice Dentistry
  • Azle, TX
  • NPI 1477758233
  NPD (past)

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

{
    "created_epoch": "1311552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571011200000",
    "number": "1598043549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 GLEN ABBEY DR",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760921378",
            "telephone_number": "347-899-5601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 INDUSTRIAL AVE",
            "city": "AZLE",
            "state": "TX",
            "postal_code": "76020",
            "telephone_number": "817-270-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "SO",
        "middle_name": "YEON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-25",
        "last_updated": "2019-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "29645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Cavender, COTA
• Certified Dementia Specialist, LLC (Dementia Specialist Home Care)
• Roney Chaluparambil Marcos, OD
• William Melvin Chambers Jr., D.O
• Cynthia Dianne Chamness, LVN
• City of Azle (Azle Fire Department)
• Brittany Collins, LCSW
• Complete Emergency Care Azle LLC
• Jeremy Corbin, DPT
• Benjamin Oscar Corrales, RN

• General Practice Dentistry in Azle, TX
• Providers in Azle, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2019; 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.