Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22DI02144900 | NJ |
N | 1223G0001X | General Practice | 049142 | NY |
N | 213EG0000X | General Practice | 049142 | NY |
NPI | 1003048844 |
---|---|
Provider Name | Dr. Joshua Seungju Chung |
First Address | Vernon, NJ 07462 |
Second Address | Vernon, NJ 07462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2009 |
Last Update Date | 18/05/2015 |