Provider Demographics
NPI:1053467514
Name:CHUNG, TAE HUN (DDS)
Entity Type:Individual
Prefix:
First Name:TAE
Middle Name:HUN
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 CHARMANT DR
Mailing Address - Street 2:#2028
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4715
Mailing Address - Country:US
Mailing Address - Phone:646-831-3966
Mailing Address - Fax:
Practice Address - Street 1:8997 MIRA MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2738
Practice Address - Country:US
Practice Address - Phone:858-536-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA553181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice