Provider Demographics
NPI:1659356152
Name:CHAN, CHUN YU (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHUN
Middle Name:YU
Last Name:CHAN
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 1:7710 SIGHTSEEING RD BLDG 2826
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-3764
Mailing Address - Country:US
Mailing Address - Phone:706-544-3103
Mailing Address - Fax:
Practice Address - Street 1:7710 SIGHTSEEING RD BLDG 2826
Practice Address - Street 2:US ARMY DENTAL ACTIVITY
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-3764
Practice Address - Country:US
Practice Address - Phone:706-544-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022323001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice