Provider Demographics
NPI:1063836393
Name:CHUNG, PETER (DMD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 SACRAMENTO AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605-1904
Mailing Address - Country:US
Mailing Address - Phone:916-371-8455
Mailing Address - Fax:916-371-1402
Practice Address - Street 1:970 SACRAMENTO AVE
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-1904
Practice Address - Country:US
Practice Address - Phone:916-371-8455
Practice Address - Fax:916-371-1402
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist