Provider Demographics
NPI:1619111465
Name:CHUNG, CHARLES CHOONG HUN (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHOONG HUN
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 1:27745 SUMMER GROVE PL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1895
Mailing Address - Country:US
Mailing Address - Phone:818-429-6486
Mailing Address - Fax:
Practice Address - Street 1:27745 SUMMER GROVE PL
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91354-1895
Practice Address - Country:US
Practice Address - Phone:818-429-6486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist