Healthcare Provider Details

I. General information

NPI: 1366218083
Provider Name (Legal Business Name): BRANDON K CHOUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PARNASSUS AVE
SAN FRANCISCO CA
94143-2210
US

IV. Provider business mailing address

707 PARNASSUS AVE
SAN FRANCISCO CA
94143-2210
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-5800
  • Fax: 415-476-3448
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41028
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: