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General NPI Number Information
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NPI Number | 1669184032
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Entity Type | Organization
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Legal Business Name | SEUNGHWAN CHUNG D.D.S., INC.
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 7291 BOULDER AVE STE 2B
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City | HIGHLAND
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State | CA
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Zip | 92346-6900
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Country | US
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Telephone | 909-425-8980
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Fax |
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Provider Business Mailing Address
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Address Line | 2117 N VILLA MARIA RD
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City | CLAREMONT
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State | CA
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Zip | 91711-1657
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Country | US
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Telephone | 909-379-9924
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SEUNGHWAN CHUNG
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Credential |
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Telephone | 909-425-8980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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