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General NPI Number Information
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NPI Number | 1508542507
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Entity Type | Individual
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Provider Name | GABRIELLA CHUNG DMD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2023
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 1171 CRESTON RD STE 107
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City | PASO ROBLES
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State | CA
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Zip | 93446-3031
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Country | US
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Telephone | 805-202-4988
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Fax |
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Provider Business Mailing Address
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Address Line | 7700 DENROCK AVE
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City | LOS ANGELES
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State | CA
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Zip | 90045-1163
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Country | US
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Telephone | 424-288-6729
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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 | PENDING
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License Number State | CA
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