Provider Demographics
NPI:1568789402
Name:CHUNG, BOKI (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOKI
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 1:28 KAMOI ST
Mailing Address - Street 2:STE 700, PO BOX 2040
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-2040
Mailing Address - Country:US
Mailing Address - Phone:808-553-4511
Mailing Address - Fax:808-553-3591
Practice Address - Street 1:28 KAMOI ST
Practice Address - Street 2:STE 700
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748-2040
Practice Address - Country:US
Practice Address - Phone:808-553-4511
Practice Address - Fax:808-553-3591
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist