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General NPI Number Information
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NPI Number | 1841807336
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Entity Type | Individual
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Provider Name | CHANVATTANAK BUN
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Gender | Male
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 1201 24TH ST
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City | BAKERSFIELD
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State | CA
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Zip | 93301-2300
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Country | US
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Telephone | 714-599-4393
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 NOBLE AVE
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City | BAKERSFIELD
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State | CA
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Zip | 93306-2637
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Country | US
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Telephone | 714-599-4393
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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 | 105599
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License Number State | CA
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