Provider Demographics
NPI:1639457948
Name:TAN, CHUN (DMD)
Entity Type:Individual
Prefix:
First Name:CHUN
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8516 BELLS RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2793
Mailing Address - Country:US
Mailing Address - Phone:443-763-6658
Mailing Address - Fax:
Practice Address - Street 1:15204 OMEGA DR STE 250
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4601
Practice Address - Country:US
Practice Address - Phone:240-580-8818
Practice Address - Fax:240-580-8819
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD150011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice