MEDICARE: DR. ROBERT MICHAEL CHUNG D.D.S

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	122300000X	Dentist	100901	CA

General Provider Information

NPI Number	:	1821547498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MICHAEL CHUNG D.D.S

Provider Business Mailing Address
First Line	:	172 W COLLEGE ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-2007
Country	:	US
Telephone Number	:	626-974-0905
Fax Number	:

Provider Business Practice Location Address
First Line	:	172 W COLLEGE ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-2007
Country	:	US
Telephone Number	:	626-974-0905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	03/12/2021

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