Provider Demographics
NPI:1689028565
Name:PING-LIN BEN CHUNG, DDS, DMSC, INC
Entity Type:Organization
Organization Name:PING-LIN BEN CHUNG, DDS, DMSC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PING-LIN
Authorized Official - Middle Name:BEN
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, DMSC
Authorized Official - Phone:909-393-5688
Mailing Address - Street 1:4200 CHINO HILLS PKWY STE 860
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3784
Mailing Address - Country:US
Mailing Address - Phone:909-393-5688
Mailing Address - Fax:909-393-5288
Practice Address - Street 1:613 N AZUSA AVE STE A
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2968
Practice Address - Country:US
Practice Address - Phone:909-393-5688
Practice Address - Fax:909-393-5288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PING-LIN BEN CHUNG, DDS, DMSC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA549431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty