Healthcare Provider Details

I. General information

NPI: 1366361362
Provider Name (Legal Business Name): ESTHER JUNG MIN CHU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 N WESTERN AVE
SAN PEDRO CA
90732-2427
US

IV. Provider business mailing address

946 N WESTERN AVE
SAN PEDRO CA
90732-2427
US

V. Phone/Fax

Practice location:
  • Phone: 310-831-0735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113502
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: