Individual provider Active NPI

Steven P. Chung, DMD

  • General Practice Dentistry
  • Manchester, CT
National Provider Identifier
1699798108
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5173 Issued in CT
Practice address
483 West Middle Turnpike
Suite 209
Manchester, CT 06040
Phone
(860) 649-3129
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5173 CT Primary

Addresses

Primary practice location

483 West Middle Turnpike
Suite 209
Manchester, CT 06040

Mailing address

483 Middle Tpke W
Suite 209
Manchester, CT 06040-3863
Phone (806) 649-3129

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20160622002428 CT Order and Referring Only - DentistPractitioner - Dentist 4385935303

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699798108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "483 MIDDLE TPKE W",
            "address_2": "SUITE 209",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403863",
            "telephone_number": "806-649-3129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "483 WEST MIDDLE TURNPIKE",
            "address_2": "SUITE 209",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "06040",
            "telephone_number": "860-649-3129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "STEVEN",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "5173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.