Provider Demographics
NPI:1619167392
Name:LUN-CHIAL, ELY MARIANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELY
Middle Name:MARIANNE
Last Name:LUN-CHIAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELY
Other - Middle Name:MARIANNE
Other - Last Name:LUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10900 WARNER AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3846
Mailing Address - Country:US
Mailing Address - Phone:714-963-5634
Mailing Address - Fax:714-964-9344
Practice Address - Street 1:10900 WARNER AVE STE 109
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3846
Practice Address - Country:US
Practice Address - Phone:714-963-5634
Practice Address - Fax:714-964-9344
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist