Healthcare Provider Details

I. General information

NPI: 1407914641
Provider Name (Legal Business Name): JOHNSON CHUEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 E 1ST ST
LOS ANGELES CA
90063-2345
US

IV. Provider business mailing address

PO BOX 3430
FULLERTON CA
92834-3430
US

V. Phone/Fax

Practice location:
  • Phone: 323-269-7367
  • Fax:
Mailing address:
  • Phone: 323-269-7367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: