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General NPI Number Information
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NPI Number | 1417264037
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Entity Type | Organization
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Legal Business Name | CHRISTINE CHUNG DENTAL CORP
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 27702 CROWN VALLEY PKWY STE A2
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City | LADERA RANCH
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State | CA
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Zip | 92694-0609
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Country | US
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Telephone | 949-365-1900
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Fax | 949-365-1909
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Provider Business Mailing Address
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Address Line | 27702 CROWN VALLEY PKWY STE A2
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City | LADERA RANCH
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State | CA
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Zip | 92694-0609
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Country | US
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Telephone | 949-365-1900
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Fax | 949-365-1909
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTINE CHUNG
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Credential | DDS
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Telephone | 949-365-1900
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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 | 43474
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 43474
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License Number State | CA
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