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General NPI Number Information
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NPI Number | 1619158367
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Entity Type | Organization
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Legal Business Name | TONY CHUNG,MD,DMD,INC.
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Dates
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Enumeration Date | 11/23/2007
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Last Update Date | 11/23/2007
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Provider Practice Location Address
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Address Line | 14600 SHERMAN WAY SUITE 260
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City | VAN NUYS
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State | CA
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Zip | 91405-2283
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Country | US
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Telephone | 818-780-2062
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Fax | 818-780-5192
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Provider Business Mailing Address
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Address Line | 14600 SHERMAN WAY SUITE 260
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City | VAN NUYS
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State | CA
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Zip | 91405-2283
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Country | US
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Telephone | 818-780-2062
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Fax | 818-780-5192
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Authorized Official
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Title or Position | CEO
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Name | DR. TONY YATSHING CHUNG
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Credential | MD,DMD
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Telephone | 818-780-2062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | OMS 11
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License Number State | CA
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