Jack Koji Chung, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019026052 Issued in IL

Practice address

60 MDG/SGDD
101 Bodin Circle
Travis Afb, CA 94535-1800

Phone

(707) 423-7000

NPI assigned

Nov 8, 2005

Sex

Male

Sole proprietor

No

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

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754956800000",
    "number": "1780665638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 MDG/SGDD",
            "address_2": "101 BODIN CIRCLE",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351800",
            "telephone_number": "707-423-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MDG/SGDD",
            "address_2": "101 BODIN CIRCLE",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351800",
            "telephone_number": "707-423-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "JACK",
        "middle_name": "KOJI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Joseph Chenaille, M.D.
• Kien Chibayere
• Moon Hee Cho
• Richard Shih-Shien Chou, M.D.
• Leslie A Christopher, WHNP
• Michael Louis Chyrek, O.D.
• Beth Clark
• Heidi Lynn Clark, RD
• Patrick James Clark Jr., O.D.
• Richard Andrew Clark, M.D

• General Practice Dentistry in Travis Afb, CA
• Providers in Travis Afb, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.