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General NPI Number Information
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NPI Number | 1346691268
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Entity Type | Individual
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Provider Name | RICHARD CHHU KUN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 5545 E BROADWAY BLVD STE 107
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City | TUCSON
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State | AZ
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Zip | 85711-3843
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Country | US
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Telephone | 520-399-7356
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Fax |
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Provider Business Mailing Address
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Address Line | 3506 GLOUCESTER GATE ST
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City | LAS VEGAS
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State | NV
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Zip | 89122-3633
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Country | US
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Telephone | 213-587-3074
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9451
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License Number State | AZ
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