Healthcare Provider Details

I. General information

NPI: 1285478594
Provider Name (Legal Business Name): LILLIAN CHUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 MONTAGUE EXPY STE 113
MILPITAS CA
95035-6827
US

IV. Provider business mailing address

2518 GLEN DUNDEE WAY
SAN JOSE CA
95148-4134
US

V. Phone/Fax

Practice location:
  • Phone: 408-935-9555
  • Fax:
Mailing address:
  • Phone: 408-887-8969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: