Provider Demographics
NPI:1376619007
Name:CHUNG, RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
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 1:321 NORTH LARCHMONT BLVD
Mailing Address - Street 2:#424
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-6404
Mailing Address - Country:US
Mailing Address - Phone:323-461-3786
Mailing Address - Fax:323-461-4942
Practice Address - Street 1:321 NORTH LARCHMONT BLVD
Practice Address - Street 2:#424
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-6404
Practice Address - Country:US
Practice Address - Phone:323-461-3786
Practice Address - Fax:323-461-4942
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice