Healthcare Provider Details

I. General information

NPI: 1831496991
Provider Name (Legal Business Name): JH CHUN DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 08/25/2022
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 TYLER ST
RIVERSIDE CA
92503-3445
US

IV. Provider business mailing address

210 W C ST
ONTARIO CA
91762-3404
US

V. Phone/Fax

Practice location:
  • Phone: 951-324-1480
  • Fax:
Mailing address:
  • Phone: 909-984-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number52047
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JIHEE CHUN
Title or Position: PRESIDENT
Credential: DDS
Phone: 909-648-3707