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General NPI Number Information
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NPI Number | 1780008334
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Entity Type | Organization
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Legal Business Name | CHUNG DENTAL GROUP
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Dates
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Enumeration Date | 02/18/2014
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 1765 E BAYSHORE RD SUITE H
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City | EAST PALO ALTO
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State | CA
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Zip | 94303-2503
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Country | US
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Telephone | 415-608-1710
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Fax |
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Provider Business Mailing Address
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Address Line | 1765 E BAYSHORE RD SUITE H
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City | EAST PALO ALTO
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State | CA
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Zip | 94303-2503
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Country | US
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Telephone | 415-608-1710
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER CHUNG
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Credential | DDS
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Telephone | 415-823-4005
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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 | 54242
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License Number State | CA
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