Provider Demographics
NPI:1437264041
Name:CHUN, BRIAN W (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:CHUN
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 1:10011 N FOOTHILL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5649
Mailing Address - Country:US
Mailing Address - Phone:408-255-8882
Mailing Address - Fax:
Practice Address - Street 1:10011 N FOOTHILL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5649
Practice Address - Country:US
Practice Address - Phone:408-255-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA325421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice