Provider Demographics
NPI:1205014925
Name:CHUNG, RICHMOND (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHMOND
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E KATELLA AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5008
Mailing Address - Country:US
Mailing Address - Phone:714-639-0412
Mailing Address - Fax:714-639-4025
Practice Address - Street 1:1500 E KATELLA AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5008
Practice Address - Country:US
Practice Address - Phone:714-639-0412
Practice Address - Fax:714-639-4025
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA476051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice