Provider Demographics
NPI:1124556469
Name:DOC CHUNG DENTAL GROUP - CHINO, INC.
Entity Type:Organization
Organization Name:DOC CHUNG DENTAL GROUP - CHINO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:WING
Authorized Official - Middle Name:YIU
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-627-8501
Mailing Address - Street 1:13197 CENTRAL AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4178
Mailing Address - Country:US
Mailing Address - Phone:909-627-8501
Mailing Address - Fax:909-627-1784
Practice Address - Street 1:13197 CENTRAL AVE STE 103
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4178
Practice Address - Country:US
Practice Address - Phone:909-627-8501
Practice Address - Fax:909-627-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty