MEDICARE: CHUNG & LEE DENTAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1750013900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHUNG & LEE DENTAL CORP

Provider Business Mailing Address
First Line	:	258 S OXFORD AVE STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-5172
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	258 S OXFORD AVE STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-5172
Country	:	US
Telephone Number	:	213-385-8242
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER CHUNG
Credential	:
Telephone Number	:	323-401-9221

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	07/03/2022

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