Provider Demographics
NPI:1407170996
Name:CHUNG, MARL SOON (DDS)
Entity Type:Individual
Prefix:
First Name:MARL SOON
Middle Name:
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 1:15622 S. CRENSHAW BLVD #B
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249
Mailing Address - Country:US
Mailing Address - Phone:310-323-9922
Mailing Address - Fax:310-515-3551
Practice Address - Street 1:15622 S. CRENSHAW BLVD #B
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249
Practice Address - Country:US
Practice Address - Phone:310-323-9922
Practice Address - Fax:310-515-3551
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist