Provider Demographics
NPI:1093116279
Name:CHUN, SIMON (DDS)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:CHUN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1554
Mailing Address - Country:US
Mailing Address - Phone:626-350-0447
Mailing Address - Fax:626-350-0225
Practice Address - Street 1:9700 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1554
Practice Address - Country:US
Practice Address - Phone:626-350-0447
Practice Address - Fax:626-350-0225
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist