Healthcare Provider Details

I. General information

NPI: 1427899111
Provider Name (Legal Business Name): BRYAN H CHUNG DMD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S CHAPARRAL CT STE 150
ANAHEIM CA
92808-2284
US

IV. Provider business mailing address

100 S CHAPARRAL CT STE 150
ANAHEIM CA
92808-2284
US

V. Phone/Fax

Practice location:
  • Phone: 714-637-4200
  • Fax: 714-637-7092
Mailing address:
  • Phone: 714-637-4200
  • Fax: 714-637-7092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ROY KIM
Title or Position: OFFICE MANAGER
Credential:
Phone: 714-637-4200