Provider Demographics
NPI:1609421452
Name:CHUNG, JOHN YEARNCHARN (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:YEARNCHARN
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E MACARTHUR BLVD UNIT 342
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-8759
Mailing Address - Country:US
Mailing Address - Phone:714-349-9736
Mailing Address - Fax:
Practice Address - Street 1:8754 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1251
Practice Address - Country:US
Practice Address - Phone:714-539-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1015961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice