Provider Demographics
NPI:1053860684
Name:PAUL CHON, DDS, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:PAUL CHON, DDS, A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-390-6775
Mailing Address - Street 1:3620 S BRISTOL ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7315
Mailing Address - Country:US
Mailing Address - Phone:626-390-6775
Mailing Address - Fax:
Practice Address - Street 1:3620 S BRISTOL ST STE 206
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7315
Practice Address - Country:US
Practice Address - Phone:626-390-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA454421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty