Provider Demographics
NPI:1114112489
Name:HUNG, EMILY (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:HUNG
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 1:34859 FREDERICK ST
Mailing Address - Street 2:106
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7007
Mailing Address - Country:US
Mailing Address - Phone:909-732-1202
Mailing Address - Fax:
Practice Address - Street 1:34859 FREDERICK ST
Practice Address - Street 2:106
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7007
Practice Address - Country:US
Practice Address - Phone:909-732-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist