Provider Demographics
NPI:1093120313
Name:NGUYEN-CHUNG, ANN (DMD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:NGUYEN-CHUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0811
Mailing Address - Country:US
Mailing Address - Phone:530-224-2700
Mailing Address - Fax:530-224-2738
Practice Address - Street 1:1441 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0811
Practice Address - Country:US
Practice Address - Phone:530-224-2700
Practice Address - Fax:530-224-2738
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist