Provider Demographics
NPI:1366458267
Name:CHUNG, CATHERINE K (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:K
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 ROYAL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4603
Mailing Address - Country:US
Mailing Address - Phone:805-526-3636
Mailing Address - Fax:805-526-7721
Practice Address - Street 1:1975 ROYAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4603
Practice Address - Country:US
Practice Address - Phone:805-526-3636
Practice Address - Fax:805-526-7721
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice