Individual provider Active NPI

Hyun Oh Chung, D.D.S.

  • Periodontics
  • New York, NY
National Provider Identifier
1639473929
Registry record updated Mar 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
055514 Issued in NY
Practice address
261 E 78TH St FL 5
New York, NY 10075-1216
Phone
(646) 864-1808
NPI assigned
Dec 31, 2010
Last updated
Mar 25, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 25, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DS038020 PA
Periodontics 1223P0300X 055514 NY Primary

Addresses

Primary practice location

261 E 78TH St FL 5
New York, NY 10075-1216

Mailing address

261 E 78TH St FL 5
New York, NY 10075-1216
Phone (646) 864-1808

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160815001928 NY Order and Referring Only - DentistPractitioner - Dentist 2163716069

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DS038020PAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Upper East Smiles, PC Dentist Current Accepting new patients

Locations

261 E 78th St
Fl 5
New York, NY 10075
Phone (646) 864-1808

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1293753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458864000000",
    "number": "1639473929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "261 E 78TH ST FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751216",
            "telephone_number": "646-864-1808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "261 E 78TH ST FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751216",
            "telephone_number": "646-864-1808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "HYUN OH",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-12-31",
        "last_updated": "2016-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS038020",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "055514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.