Provider Demographics
NPI:1609099365
Name:HAN, CHUNG HUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHUNG HUN
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:HUN
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5617 E BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-2803
Mailing Address - Country:US
Mailing Address - Phone:323-721-7600
Mailing Address - Fax:626-287-6921
Practice Address - Street 1:9675 E LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2103
Practice Address - Country:US
Practice Address - Phone:626-287-6688
Practice Address - Fax:626-287-6921
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist