Provider Demographics
NPI:1245232396
Name:CHAN, KUNIO KWOK-HUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:KUNIO
Middle Name:KWOK-HUNG
Last Name:CHAN
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 1:111 DOW AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-7139
Mailing Address - Country:US
Mailing Address - Phone:617-458-2259
Mailing Address - Fax:978-215-5723
Practice Address - Street 1:655 BOSTON RD
Practice Address - Street 2:UNIT 3A
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-5338
Practice Address - Country:US
Practice Address - Phone:617-458-2259
Practice Address - Fax:978-215-5723
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212621223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice