Individual provider Active NPI

Alexander Yong-Kwon Chung, D.D.S.

  • Prosthodontics
  • Anaheim, CA
National Provider Identifier
1801051776
Registry record updated Jun 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
44466 Issued in CA
Practice address
215 N State College Blvd Ste J
Anaheim, CA 92806-2995
Phone
(714) 333-0770
Fax
(657) 208-3373
NPI assigned
Jul 21, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 44466 CA Primary

Addresses

Primary practice location

215 N State College Blvd Ste J
Anaheim, CA 92806-2995

Mailing address

215 N State College Blvd Ste J
Anaheim, CA 92806-2995
Phone (714) 333-0770

Other practice location 1

2118 S Hacienda Blvd
Hacienda Heights, CA 91745-4242
Phone (626) 369-9998

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
44466CAMDProsthodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Alexander Yong-Kwon Chung Dental Corporation Prosthodontics Current Accepting new patients

Locations

215 N State College Blvd
Ste J
Anaheim, CA 92806
Phone (714) 333-0770

2118 S Hacienda Blvd
Hacienda Heights, CA 91745
Phone (626) 333-1672

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1216598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593302400000",
    "number": "1801051776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 N STATE COLLEGE BLVD STE J",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928062995",
            "telephone_number": "714-333-0770",
            "fax_number": "657-208-3373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N STATE COLLEGE BLVD STE J",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928062995",
            "telephone_number": "714-333-0770",
            "fax_number": "657-208-3373"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2118 S Hacienda Blvd",
            "address_purpose": "LOCATION",
            "city": "Hacienda Heights",
            "state": "CA",
            "postal_code": "917454242",
            "country_code": "US",
            "telephone_number": "626-369-9998",
            "fax_number": "626-369-9993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "ALEXANDER",
        "middle_name": "YONG-KWON",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-21",
        "last_updated": "2020-06-28",
        "certification_date": "2020-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CA",
            "license": "44466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2020; 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.