Healthcare Provider Details

I. General information

NPI: 1861311664
Provider Name (Legal Business Name): SARA LAUREN PHUNG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 GRAND AVE STE F
CHINO HILLS CA
91709-1473
US

IV. Provider business mailing address

1709 FERN HOLLOW DR
DIAMOND BAR CA
91765-2728
US

V. Phone/Fax

Practice location:
  • Phone: 909-364-0001
  • Fax:
Mailing address:
  • Phone: 909-348-4609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: