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General NPI Number Information
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NPI Number | 1700831963
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Entity Type | Individual
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Provider Name | JACKIE CHUNG DDS
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Gender | Female
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | SANTA BARBARA COMMUNITY BASED OUTPATIENT CLINIC 4440 CALLE REAL AVE
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City | SANTA BARBARA
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State | CA
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Zip | 93110-8639
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Country | US
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Telephone | 805-638-1491
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Fax |
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Provider Business Mailing Address
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Address Line | 228 W. VICTORIA AVE #6
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City | SANTA BARBARA
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State | CA
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Zip | 93105
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 009283
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License Number State | CT
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