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Dr. Jack Koji Chung , DDS

Dentist - General Practice β€’ Travis Afb, CA

Active NPI 1780665638 Individual Practitioner Male Practitioner
Practice location in NPPES

60 Mdg/sgdd, 101 Bodin Circle
Travis Afb, CA 945351800

Call 7074237000 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

60 Mdg/sgdd
101 Bodin Circle

Travis Afb, CA 945351800

Telephone 7074237000

Industry payments (Open Payments)

No Open Payments records are listed for this clinician for 2019–2025.

Guide: How to read an Open Payments record

NPI first issued

2005

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

Medicare assignment not listed

CMS data do not show whether this clinician accepts Medicare assignment. This does not mean they do not accept Medicare. Ask the office.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Enrolled in Medicare (PECOS)

Dr. Chung has a Medicare enrollment record in PECOS, the CMS system clinicians use to enroll so they can bill Medicare or order services for people with Medicare.

It does not show whether the clinician accepts assignment, is in your plan's network, or is taking new patients.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What Medicare enrollment (PECOS) means

Can order Medicare-covered services

CMS lists Dr. Chung as eligible to order or refer Medicare Part B clinical laboratory and imaging services, durable medical equipment (DME) and home health services for people with Medicare.

What this does not show: Can order Medicare-covered services

It does not mean the clinician offers these services directly.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What ordering and referring status means

Compared with the same specialty in Travis Afb and California

22 active clinicians are listed under Dentist - General Practice with a practice address in Travis Afb, CA (17,862 in California).

Addresses are self-reported to NPPES and may be out of date.

Telehealth indicator in Travis Afb

0% of these 22 clinicians have the CMS telehealth indicator.

0% of these 22 clinicians are listed by CMS as accepting Medicare assignment.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2025-08-07
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

License # reported to NPPES IL 019026052

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Medical Board of California.
Look Up on State Board Site

Medicare (PECOS) Enrollment & Ordering Eligibility

Source: CMS PECOS
Medicare FFS Enrollment Status Medicare Enrollment on File
CMS Provider Specialty

ORDER AND REFERRING ONLY - ORAL SURGERY

Medicare Enrollment ID

I20140617002553

Enrollment State Jurisdiction

FL

PECOS Control ID

3779707542

Medicare Order & Referring Eligibility
Clinical Lab & Imaging (Part B) Eligible
Durable Medical Equipment (DME) Eligible
Home Health Agency (HHA) Eligible
Power Mobility Devices (PMD) Not Eligible

Sources: CMS Provider Enrollment and Order and Referring. Medicare enrollment is a billing status, not an accreditation or quality rating.

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

16 Historical Events
πŸ“
Updated Practice Location August 12, 2025

Registered at 60 MDG/SGDD, 101 BODIN CIRCLE, TRAVIS AFB, CA 945351800 (Tel: 7074237000)

πŸ“
Updated Business Mailing Address August 12, 2025

Registered at 60 MDG/SGDD, 101 BODIN CIRCLE, TRAVIS AFB, CA 945351800 (Tel: 7074237000)

πŸ“
Updated Practice Location July 11, 2025

Registered at 60 MDG, 101 BODIN CIRCLE, TRAVIS AFB, CA 945351800 (Tel: 7074237000)

πŸ“
Updated Business Mailing Address July 11, 2025

Registered at 60 MDG, 101 BODIN CIRCLE, TRAVIS AFB, CA 945351800 (Tel: 7074237000)

πŸ“
Updated Practice Location October 25, 2022

Registered at 374TH MEDICAL GROUP UNIT 5071, APO, AP 963285071 (Tel: 0118142552)

πŸ“
Updated Business Mailing Address October 25, 2022

Registered at 374TH MEDICAL GROUP UNIT 5071, YOKOTA AB, APO, AP 96328 (Tel: 0118142552)

πŸ“
Updated Practice Location April 05, 2021

Registered at 18TH MEDICAL GROUP UNIT 5142, APO, AP 963685142 (Tel: 0118180942)

πŸ“
Updated Practice Location August 01, 2019

Registered at 18TH MEDICAL GROUP, APO, AP 96368 (Tel: 0118180942)

πŸ“
Updated Business Mailing Address August 01, 2019

Registered at 18TH MEDICAL GROUP, UNIT 5142, APO, AP 96368

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) August 01, 2019

Dentist (license number reported to NPPES: IL 019026052)

βœ…
NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) July 08, 2007

Registered at 374 DENTAL CLINIC, APO, AP 96326 (Tel: 0118131175)

πŸ“
Business Mailing Address (Initial Record) July 08, 2007

Registered at PSC 78 BOX 1781, APO, AP 96326 (Tel: 0118131175)

πŸ‘€
Provider Name / Credentials (Initial Record) July 08, 2007

Recorded as JACK CHUNG, DDS

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist

🟒
Initial NPI Registration & Enumeration November 08, 2005

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1780665638
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 08, 2005
Last Update: August 12, 2025
Sole Proprietor: No

Mailing Address

60 Mdg/sgdd, 101 Bodin Circle

Travis Afb, CA 945351800

Phone: 7074237000

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.