Healthcare Provider Details

I. General information

NPI: 1740547264
Provider Name (Legal Business Name): CHA HUR D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHA AE GLORIA HUR D.D.S.

II. Dates (important events)

Enumeration Date: 04/22/2012
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 N LOS COYOTES DIAGONAL STE 200
LONG BEACH CA
90808-3938
US

IV. Provider business mailing address

3320 N LOS COYOTES DIAGONAL STE 200
LONG BEACH CA
90808-3938
US

V. Phone/Fax

Practice location:
  • Phone: 562-377-1375
  • Fax:
Mailing address:
  • Phone: 562-377-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number64525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: