| NPI | 1790180693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEHYUN CHONG Dentist 718-358-5488 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 051051) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 051035) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 051829) | |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2014-11-04 |