Provider Demographics
NPI:1083706444
Name:CHUNG, CHRISTINE HUYEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:HUYEN
Last Name:CHUNG
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 1:24310 MOULTON PKWY
Mailing Address - Street 2:SUITE C1
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3306
Mailing Address - Country:US
Mailing Address - Phone:714-859-3988
Mailing Address - Fax:949-859-3578
Practice Address - Street 1:24310 MOULTON PKWY
Practice Address - Street 2:SUITE C1
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-3306
Practice Address - Country:US
Practice Address - Phone:714-859-3988
Practice Address - Fax:949-859-3578
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-089-6800OtherTAX I.D.NUMBER
CAG91961-01OtherDENTI-CAL