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General NPI Number Information
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NPI Number | 1376938522
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Entity Type | Individual
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Provider Name | DR. ERIC CHUNG
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Gender | Male
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Dates
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Enumeration Date | 04/04/2015
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 14600 SHERMAN WAY STE 260
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City | VAN NUYS
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State | CA
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Zip | 91405-2285
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Country | US
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Telephone | 818-780-2062
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Fax |
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Provider Business Mailing Address
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Address Line | 4249 W MCFARLANE AVE
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City | BURBANK
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State | CA
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Zip | 91505-4019
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Country | US
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Telephone | 818-645-2550
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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 | DS040613
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 197411
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License Number State | CA
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