Provider Demographics
NPI:1285667972
Name:CHUNG, KRISTY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KYUNG
Other - Middle Name:WON
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:860 E. REMINGTON DR. SUITE A
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087
Mailing Address - Country:US
Mailing Address - Phone:408-675-1700
Mailing Address - Fax:408-542-9797
Practice Address - Street 1:860 E. REMINGTON DR. SUITE A
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087
Practice Address - Country:US
Practice Address - Phone:408-675-1700
Practice Address - Fax:408-542-9797
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206931223X0400X
CA515631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0204358Medicaid