Healthcare Provider Details

I. General information

NPI: 1215724596
Provider Name (Legal Business Name): SAE HWAN CHUNG DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34488 YUCAIPA BLVD STE F
YUCAIPA CA
92399-2482
US

IV. Provider business mailing address

25519 CARROL CT
LOMA LINDA CA
92354-3700
US

V. Phone/Fax

Practice location:
  • Phone: 909-797-0303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SAE HWAN CHUNG
Title or Position: CEO
Credential: DDS
Phone: 909-953-5142