Provider Demographics
NPI:1346336708
Name:CHUNG, JOHN WILKIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILKIE
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 KINMAN AVE
Mailing Address - Street 2:STE C
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117
Mailing Address - Country:US
Mailing Address - Phone:805-967-1231
Mailing Address - Fax:805-967-1232
Practice Address - Street 1:164 KINMAN AVE
Practice Address - Street 2:STE C
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117
Practice Address - Country:US
Practice Address - Phone:805-967-1231
Practice Address - Fax:805-967-1232
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47060122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist