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General NPI Number Information
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NPI Number | 1831754100
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Entity Type | Individual
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Provider Name | NA EUN CHUNG DMD
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Gender | Female
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 3123 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90006-2462
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Country | US
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Telephone | 213-487-5961
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Fax | 213-487-5962
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Provider Business Mailing Address
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Address Line | 3123 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90006-2462
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Country | US
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Telephone | 213-487-5961
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 103117
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License Number State | CA
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