Provider Demographics
NPI:1073031159
Name:CHUN, CHRISTINA HAE-JUNG (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:HAE-JUNG
Last Name:CHUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 MOHAWK ST UNIT 6
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-6331
Mailing Address - Country:US
Mailing Address - Phone:703-474-0414
Mailing Address - Fax:
Practice Address - Street 1:1021 W AVENUE M14
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1440
Practice Address - Country:US
Practice Address - Phone:703-474-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1016651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty