Provider Demographics
NPI:1417264037
Name:CHRISTINE CHUNG DENTAL CORP
Entity Type:Organization
Organization Name:CHRISTINE CHUNG DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-365-1900
Mailing Address - Street 1:27702 CROWN VALLEY PKWY STE A2
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0609
Mailing Address - Country:US
Mailing Address - Phone:949-365-1900
Mailing Address - Fax:949-365-1909
Practice Address - Street 1:27702 CROWN VALLEY PKWY STE A2
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0609
Practice Address - Country:US
Practice Address - Phone:949-365-1900
Practice Address - Fax:949-365-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43474122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty