Active NPI
Ho Ryun Chung, D.D.S
- General Practice Dentistry
- Milford, CT
National Provider Identifier
1881979672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 010653
- Practice address
- 170 W Main St
Apt# 205K
Milford, CT 06460-2562 - Phone
- (714) 334-5001
- NPI assigned
- Oct 12, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 010653 | CT | |
| Dentist | 122300000X | 055859 | NY | |
| General Practice Dentistry | 1223G0001X | 010653 | CT | Primary |
Addresses
Primary practice location
170 W Main St
Apt# 205K
Milford, CT 06460-2562
Mailing address
170 W Main St
Apt#205K
Milford, CT 06460-2562
Phone (714) 334-5001
Other names 1
- Philip Horyun Chung
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
| License | State | Type | Specialty |
|---|---|---|---|
| 010653 | CT | MD | Dentist |
| 055859 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lodestar Dental LLC | General Practice | Past | Accepting new patients |
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.
-
- General Practice Dentistry
- New Haven, CT
- NPI 1962952606
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358121600000",
"number": "1881979672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "170 W MAIN ST",
"address_2": "APT#205K",
"city": "MILFORD",
"state": "CT",
"postal_code": "064602562",
"telephone_number": "714-334-5001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "170 W MAIN ST",
"address_2": "APT# 205K",
"city": "MILFORD",
"state": "CT",
"postal_code": "064602562",
"telephone_number": "714-334-5001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHUNG",
"first_name": "HO",
"middle_name": "RYUN",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-12",
"last_updated": "2013-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CT",
"license": "010653",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "055859",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CT",
"license": "010653",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "PHILIP",
"last_name": "CHUNG",
"middle_name": "HORYUN",
"credential": "D.D.S",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Milford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.