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General NPI Number Information
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NPI Number | 1881371789
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Entity Type | Individual
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Provider Name | TYLER CHUNG DDS
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Gender | Male
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 1115 S SANDERSON AVE
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City | HEMET
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State | CA
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Zip | 92545-9047
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Country | US
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Telephone | 951-404-5307
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Fax |
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Provider Business Mailing Address
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Address Line | 813 E SUNSET DR N
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City | REDLANDS
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State | CA
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Zip | 92373-7649
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Country | US
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Telephone | 909-633-1966
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 110838
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License Number State | CA
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