Provider Demographics
NPI:1346363652
Name:CHUNG, DANIEL D (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:D
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 1:8884 KNOTT AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4135
Mailing Address - Country:US
Mailing Address - Phone:714-995-5000
Mailing Address - Fax:714-995-5125
Practice Address - Street 1:8884 KNOTT AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4135
Practice Address - Country:US
Practice Address - Phone:714-995-5000
Practice Address - Fax:714-995-5125
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice