Provider Demographics
NPI:1174653844
Name:CHUN, KALFRED GS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KALFRED
Middle Name:GS
Last Name:CHUN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1001 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6605
Mailing Address - Country:US
Mailing Address - Phone:805-922-2295
Mailing Address - Fax:805-922-1166
Practice Address - Street 1:1001 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6605
Practice Address - Country:US
Practice Address - Phone:805-922-2295
Practice Address - Fax:805-922-1166
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics