=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134788615
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANNAH YUNI CHUNG DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2019
-----------------------------------------------------
Last Update Date | 01/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 926 FRANKLIN BLVD
-----------------------------------------------------
City | LEMOORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93246-4500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-998-2427
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | BLDG H 2005 KNIGHT LANE
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-725-3213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 11524786-9921
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------