Healthcare Provider Details

I. General information

NPI: 1902329402
Provider Name (Legal Business Name): ELIZABETH TING YU CHAK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2407 ATLANTIC AVE
LONG BEACH CA
90806-3221
US

IV. Provider business mailing address

27898 VIOLET
MISSION VIEJO CA
92691-6688
US

V. Phone/Fax

Practice location:
  • Phone: 562-981-1000
  • Fax:
Mailing address:
  • Phone: 949-331-2537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS041285
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS102378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: