Provider Demographics
NPI:1548385685
Name:CHUNG, YU-CHI RICKY (DDS)
Entity Type:Individual
Prefix:DR
First Name:YU-CHI
Middle Name:RICKY
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 1:17122 SLOVER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-7588
Mailing Address - Country:US
Mailing Address - Phone:909-829-3994
Mailing Address - Fax:
Practice Address - Street 1:17122 SLOVER AVE STE 103
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7588
Practice Address - Country:US
Practice Address - Phone:909-829-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5181122300000X
CA55244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1548385685Medicaid