Provider Demographics
NPI:1083752547
Name:AUNG, MICHAEL MAUNG (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MAUNG
Last Name:AUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MAUNG
Other - Middle Name:MAUNG
Other - Last Name:AUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3527 LINDA LEE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2012
Mailing Address - Country:US
Mailing Address - Phone:626-572-9172
Mailing Address - Fax:626-572-9172
Practice Address - Street 1:1434 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3656
Practice Address - Country:US
Practice Address - Phone:626-571-8210
Practice Address - Fax:626-573-3460
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice